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guides to osseointegration
“CONCEPT OF OSSEOINTEGRATION”
Methods of Mechanism of
evaluation of osseointegration
osseointegration
Factors effecting
osseointegration
Definitions
“The apparent direct attachment or connection of
osseous tissue to an inert, alloplastic material
without intervening connective tissue”.
GPT 8
Structurally oriented definition
“Direct structural and functional connection between
the ordered, living bone and the surface of a load
carrying implants”.
- Branemark and associates (1977)
Histologically
Woven bone
Lamellar bone
Bundle bone
Woven bone
R/Q
F
• Remodelling cycle = 17 weeks in humans
• Remodelling includes :
1. Localized changes in individual osteons
or trabeculae
2. Turnover, hypertrophy,atrophy or
reorientation .
Bone to implant interface
There are two basic theories
Osseointegration
(Branemark 1985)
Fibro-osseous
integration
Linkow 1976
James 1975
Weiss 1986
FIBROINTEGRATION OSSEOINTEGRATION
Vs
Blood clot
Phagocytic
PMNL
cells
Procallus ( contains
fibroblast)
Callus (contains
osteoblast)
Remodelling
Bone
Bone tissue response
Implant biocompatibility
Design characteristics
Surface characteristics
State of the host bed
Surgical technique and
Loading conditions
Implant Biocompatibility
Cylindrical implants
Press fit root form implants depend on
coating or surface condition to provide
microscopic retention and bonding to the
bone
Bone saucerization ?
Non threaded Threaded
• Thread shape
• Thread pitch
• Thread depth
Grooves on the threads of all implants and
on the collars, whereever appropriate.
Increase surface area
Increase area for bone-to-implant contact
Implant Surface (Microstructure,
Surface Topography)
“The extent of bone implant interface is
positively correlated with an increasing
roughness of the implant surface”
Roughened surface
Greater bone to implant contact at
histological level
Micro irregularities - cellular adhesion.
High surface energy - improved cellular
attachment.
• Roughness parameter (Sa)
0.04 –0.4 m - smooth
0.5 – 1.0 m – minimally rough
1.0 –2.0 m – moderately rough
2.0 m – rough
Hydroxyapaptite 79%
Ion implantation 68% 61%
Laser treated 38%
State of the host bed
• Quality I
composed of homogenous compact
bone found in the lower anterior
• Quality II
• Quality IV
Very thin layer of cortical bone surrounding
a core of low-density trabecular bone
- very soft bone found in the
upper anterior and posterior
• Branemark system (5 year documentation)
• Mandible – 95% success
• Maxilla – 85-90% success
According to Branemark and Misch
D1 and D2 bone initial stability / better
osseointegration
D3 and D4 poor prognosis
D1 bone – least risk
D4 bone - most at risk
Selection of implant
• D1 and D2 – conventional threaded implants
• D3 and D4 – HA coated or Titanium plasma coated
implants
Surgical Considerations
Promote regenerative type of the bone
healing rather than reparative type of the
bone healing.
The critical time/ temperature - bone tissue
necrosis - 47° for one minute.
Recommendations
Slow speed
Graded series
Adequate cooling
Bone cutting speed of less than 2000 rpm
Tapping at a speed of 15 rpm with irrigation
Using sharp drills
The optimal torque threshold – 35 N/cm.
Implant should gently engage the bone in order
to avoid too much pressure at the bone
interface which could jeopardize healing
Surgical skill / technical excellence
Loading conditions
Progressive or two stage loading
Immediate or one stage or
nonsubmerged loading
Progressive or two stage loading
• Immediate loading:
1. Immediate occlusal loading (placed
within 48 hours)
• Active chemotherapy
Formation of bone
Formation of collagen
matrix
Maintenance of
Bone remodelling
osseointegration
Valero AM, Ferrer García JC, Ballester AH, Rueda CL. Effects of diabetes
on the osseointegration of dental implants. Med Oral Patol Oral Cir Bucal
2007;12:E38-43
• Patients who were smokers at the time of implant
surgery had a significantly higher implant failure
rate (23.08%) than non-smokers (13.33%)
Subperiosteal 39 - 90
Staple 95
Vitreous carbon 50
Blade 65 - 90
Osseointegrated 80 - 100
Possible criteria for success
• Mobility
• Peri-implant radiolucency
• Marginal bone loss
• Sulcus depth
• Gingival status
• Damage to adjacent teeth
• Violation of maxillary sinus , mandibular
canal or floor of nasal cavity
• Appearance
• Length of service
Condition for application of criteria
• Only osseointegrated implants should be evaluated
with these criteria.
b) 0 mobility
d) No exudates history
• Osseointegration.ppt
• http://www.ecf.utoronto.ca/~bonehead/