osseointegration

Loma Linda University

Implant Dentistry


Implant Dentistry

OSSEOINTEGRATION


Implant Dentistry

Concepts of the Interface

Clinical Applications


Implant Dentistry

In 1952, Prof. Per-Ingvar In 1952, Prof. Per-Ingvar Brånemark of Sweden conducted Brånemark of Sweden conducted an experiment where he utilized a an experiment where he utilized a titanium implant chamber to study titanium implant chamber to study blood flow in rabbit bone. At the blood flow in rabbit bone. At the conclusion of the experiment, when conclusion of the experiment, when it became time to remove the it became time to remove the titanium chambers from the bone, titanium chambers from the bone, he discovered that the bone had he discovered that the bone had integrated so completely with the integrated so completely with the implant that the chamber could not implant that the chamber could not be removed.be removed. Brånemark called the discovery Brånemark called the discovery “Osseointegration” “Osseointegration”

Prof. Per-Ingvar BrånemarkProf. Per-Ingvar Brånemark


Implant Dentistry

Osseointegration is a Osseointegration is a biological concept. biological concept.

"Direct structural "Direct structural connection between connection between ordered, living bone and ordered, living bone and the surface of the load-the surface of the load-carrying implant"carrying implant"

OSSEOINTEGRATIONOSSEOINTEGRATION

PI. Branemark


Implant Dentistry

OSSEOINTEGRATIONOSSEOINTEGRATIONIn May of 1982, George Zarb, a

Professor from Toronto University, organized the Toronto Conference on Osseointegration in Clinical Dentistry.


Implant Dentistry

OSSEOINTEGRATION


Implant Dentistry1976-1982


Implant Dentistry

Ligament

Fibro-integration

Capsule

Connective TissueInterface


Implant Dentistry

John BrunskiJ Dent Res 1979


Implant Dentistry

Veterans Administration Cooperative Dental Implant Study--comparisons between fixed partial dentures supported by blade-vent implants and removable partial dentures.

Part II: Comparisons of success rates and periodontal health between two treatment modalities.

Kapur KK. J Prosthet Dent. 1989 Dec;62(6):685-703.


Implant Dentistry

Five Veterans Administration centers have participated in a study to determine whether fixed partial dentures (FPDs) supported by blade implants offer an acceptable substitute for mandibular unilateral or bilateral distal-base extension removable partial dentures (RPDs).

Life table analysis showed 5-year success rates of 84.2% for the FPD and 74% for the RPD.

Kapur KK. J Prosthet Dent. 1989 Dec;62(6):685-703.


Implant Dentistry

A 15-year study of osseointegrated implants in the treatment of the edentulous jaw.

Adell R, Lekholm U, Rockler B, Brånemark PI. Int J Oral Surg. 1981 Dec;10(6):387-416.


Implant Dentistry

The results of standardized procedures applied on a consecutive clinical material with an observation time of 5-9 years were thought to properly reflect the potential of the method. In this group, 130 jaws were provided with 895 fixtures, and of these 81% of the maxillary and 91% of the mandibular fixtures remained stable, supporting bridges.



Implant Dentistry

During healing and the first year after connection of the bridge, the mean value for marginal bone loss was 1.5 mm. Thereafter only 0.1 mm was lost annually. The clinical results achieved with bridges on osseointegrated fixtures fulfill and exceed the demands set by the 1978 Harvard Conference on successful dental implantation procedures.



Implant Dentistry


Implant Dentistry

http://www.cda.org/page/Library/cda_member/pubs/journal/jour1101/history


Implant Dentistry

Os-seo-in-te-gra-tion(oss”e-o-in”te-

gra’shen)

Direct integration of an implant by the formation of boney tissue around the implant

without the growth of fibrous tissue at the bone-implant

interface

Dorland’s Illustrated Medical Dictionary, 28th Ed. (WB Saunders, 1994)


Implant Dentistry

Titanium

MachinedMachined Grit-BlastGrit-BlastHAHATPSTPS

• Common metal, lightweight, corrosion resistant.

• Spontaneously forming a surface coating of titanium oxide (TiO2).

• Initial 50-100 Å reactive surface becomes coated with plasma proteins (fibronectin & vitronectin)

• Biologic Inertness.


Implant Dentistry

Titanium• The reactive oxide is

sensitive to the way in which the surface of the implant is clean and sterilized.

• Surface contaminants may influence the biologic response to implants.

• Surface chemistry, surface energy, and surface topography also influence biologic response.


Implant Dentistry

•Placement generates trauma

•Minimal heat generation (<47ºC for 1 minute or less)

•Clot

•Minor Inflammatory Response

•Proliferation and Differentiation of Phagocytes and UMC


Implant Dentistry

Woven Callus 6w

Lamellar Compaction 18w

Interface Remodeling 18w

Compacta Maturation 54w

Biology of Osseointegration

Roberts, E.W.Bone Tissue Interface

J Dent Ed 1988


Implant DentistryFollowing initial placement, 0.5mm bone next to Following initial placement, 0.5mm bone next to

implant will become necrotic.implant will become necrotic.

Ingrowths of vascular loops will occur at the rate of Ingrowths of vascular loops will occur at the rate of 0.5mm per day. (Woven Callus)0.5mm per day. (Woven Callus)

Remodeling phase with Remodeling phase with hematopoietic-derived hematopoietic-derived osteoclastic cells form osteoclastic cells form cutting cones that will cutting cones that will remove the established remove the established woven matrix. woven matrix. (40µm per day)(40µm per day)

Following resorptive cutting Following resorptive cutting cones, an osteogenic front ofcones, an osteogenic front oflamellar differentiation occurs. lamellar differentiation occurs.


Implant Dentistry

Scanning electron micrograph showing a bone cell attaching to titanium


Implant Dentistry

Bone implant interface

25% to 75%

Three to four months post-insertion.


Implant Dentistry

The excessive loss of Branemark fixtures in type IV bone:

A 5-year analysis.

Jaffin RA, Berman CL. J Periodontol. 1991 Jan;62(1):2-4.


Implant Dentistry

Ninety percent of 1,054 implants placed were in Types I, II, and III bone. Only 3% of these fixtures were lost; of the 10% of the fixtures placed in Type IV bone, 35% failed. Presurgical determination of Type IV bone may be one method to decrease implant failure.

Jaffin RA, Berman CL. J Periodontol. 1991 Jan;62(1):2-4.


Implant Dentistry

Effect of Poor Bone Quality Effect of Poor Bone Quality #Implants Type 1-3 Bone Failures (%) Type 4 Bone Failures (%) #Implants Type 1-3 Bone Failures (%) Type 4 Bone Failures (%)

Engquist '88 141 15 198 52 Engquist '88 141 15 198 52 van S.ghe '90 491 19 67 4 van S.ghe '90 491 19 67 4 Jaffin '91 952 29 102 36 Jaffin '91 952 29 102 36 Johns '92 453 16 57 16 Johns '92 453 16 57 16 Fugazzotto '93 851 12 512 22 Fugazzotto '93 851 12 512 22 Smedberg '93 53 0 33 12 Smedberg '93 53 0 33 12

% Failure relative to % Failure relative to # Implants placed # Implants placed

2,938 91 (3) 969 143 (15)2,938 91 (3) 969 143 (15)

97% 85%


Implant Dentistry

Surface and Design


Implant Dentistry

Implant macro-retentive features.Screw threadsSolid body press-fitSintered bead surface


Implant Dentistry

Implant micro-retentive features. Surface Roughness

MacroscopicMicroscopic


Implant Dentistry

Implant micro-retentive features. Surface Roughness

Additive Methods (TPS-HA)Subtractive Methods (SLA, Ti Oxide)


Implant Dentistry

Hydroxyapatite Surfaces


Implant Dentistry


Implant Dentistry


Implant Dentistry

Stage I. Initial contact with surface & anchorage via filapodia

Stage II. cells with lamellipodia

Stage III. circumferential spreading

Stage IV. full spreading & flattening

I. II.

III.

IV.

Classification of cell attachment Rajaraman et al 1974


Implant Dentistry

a. stage 1 b. stages 1, 2, 3

Turned Implants


Implant Dentistry

An implant surface has an optimal balance between An implant surface has an optimal balance between pore size on the surface (pore sizes of 1-5µm diameter pore size on the surface (pore sizes of 1-5µm diameter and 1-5µm in depth) which optimizes the shear and 1-5µm in depth) which optimizes the shear strength of the individual bone In-growth into anyone strength of the individual bone In-growth into anyone pit with the need to have as many “pits” on the pit with the need to have as many “pits” on the surface as possible.surface as possible.


Implant DentistryMechanisms of bone healing around

surface treated dental implants

distance osteogenesis: distance osteogenesis:

no bone bonding onto surface no bone bonding onto surface

contact osteogenesis: contact osteogenesis: de novo bone formationde novo bone formation


Implant Dentistry

source:A. Piattelli


Implant Dentistry

Overview

Contact osteogenesis can be subdivided into three distinct phases: Osteoconduction: migration of osteogenic cells to implant surface, through a temporary connective tissue scaffold. Anchorage of this scaffold to the surface is a function of surface morphology


Implant Dentistry

Overview

De novo bone formation: Will result in mineralized interfacial matrix laid down on the implant surface. Surface topography determines if interfacial bone formed is bonded to the implant.


Implant Dentistry

Overview

Bone remodeling: Creation of bone-implant interface comprising de novo bone formation


Implant Dentistry


Implant DentistrySmooth VS Surface Treatment


Implant DentistrySmooth VS Surface Treatment


Implant Dentistry

Ti Alloy CP Ti HA

100

200

300

Ncm

Increased Attachment Strength

CARR et al: JOMI 1995


Implant Dentistry

JHONSON B. HA COATED IMPLANTS. LONG TERM CONSEQUENCES.

JCDA 1992


Implant Dentistry

Titanium HA Coated Surface


Implant DentistryCurrent Designs


Implant Dentistry


Implant Dentistry

Premature loading may lead to fibrous tissue encapsulation (Albrektsson, 1981; 1986)

Necrotic bone at the implant bed border (the result of an implant osteotomy) is not capable of load-bearing. (Branemark, 1983)

80’s


Implant Dentistry

Dr. Glauser, Switzerland

Machined Oxidized 12w


Implant Dentistry

% Bone-to-metal contact

coronal 42.3 %apical 72.1 %total 57.5 %

coronal 29.9 %apical 33.3 %total31.6 %

Machined Oxidized


Implant Dentistry

Dr. Glauser, Switzerland

Immediate loading posterior maxilla


Implant Dentistry

[Hz]

Immediate loading posterior maxilla

Applied Osseointegration Research 2001

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Implant Dentistry

Immediate Loading

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