Osseointegration

Osseointegration, definition, history, process of osseointegration, factors influencing osseointegration, methods for evaluation of osseointegration, failure of osseointegration

1. OSSEOINTEGRATI ON

2. INTRODUCTION HISTORICAL REVIEW DEFINITIONS FIBROOSSEOUS INTEGRATION MECHANISM OF OSSEOINTEGRATION BONE TO IMPLANT INTERFACE HISTORY OF BRANEMARK SYSTEM BONE FORMATION AROUND IMPLANTS STAGES BONETISSUE RESPONSE BIOLOGICAL ATTACHMENT BIOLOGICAL PROCESS OF INTEGRATION MECHANISM OF INTEGRATION FACTORS THAT INFLUENCE OSSEOINTEGRATION METHODS OF EVALUATION FAILURES CONCLUSION FUTURISTIC CONCEPTS

3. INTRODUCTION Osseointegration derives from ‘ osteon ,’ the Greek word for bone and the Latin word for ‘to make whole’ which is integrate. This refers to the process that will take place between the living bone and the surface of implant.

4. HISTORICAL REVIEW The concept of Osseointegration was developed and the term was coined by Dr. Per-Ingvar Branemark , Professor at the institute for Applied Biotechnology, University of Goteborg, Sweden .

5. HISTORY OF BRANEMARK SYSTEM

6. DEFINITIONS Structurally oriented definition “Direct structural and functional connection between the ordered, living bone and the surface of load carrying implants”. - Branemark and associates (1977) “The apparent direct attachment or connection of osseous tissue to an inert, alloplastic material without intervening connective tissue”. - GPT 8

7. “It is a process where by clinically asymptomatic rigid fixation of alloplastic material is achieved and maintained in bone during functional loading” - Zarb and T Albrektsson (19 86 )

8. Biomechanically oriented definition “Attachment resistant to shear as well as tensile forces” - Steinmann et al (1986).

9. BONE TO IMPLANT INTERFACE TWO BASIC THEORIES : OSSEOINTEGRATION (BRANEMARK 1985) FIBRO-OSSEOUS INTEGRATION (LINKOW 1976 JAMES 1975 WEISS 1986)

10. BONE TO IMPLANT INTERFACE Meffert et al (1987) ADAPTIVE- OSSEOINTEGRATION BIOINTEGRATION Osseointegration

11. In 1986,the American Academy of Implant Dentistry(AAID) defined Fibrointegration as “Tissue to implant contact with interposition healthy dense collagenous tissue between the implant and bone’’

12. FIBRO-OSSEOUS INTEGRATION Presence of connective tissue between the implant and bone . Collagen fibers functions similarly to Sharpey’s fibers found in natural dentition. The fibers are arranged irregularly, parallel to the implant body, when forces are applied they are not transmitted through the fibers. “ Pseudoligament ”, “ Periimplant ligament”, “ Periimplant membrane”.

13. FAILURE OF FIBRO-OSSEOUS THEORY No real evidence Forces are not transmitted through the fibers - remodeling was not expected . Forces applied resulted in widening fibrous encapsulation, inflammatory reactions, and gradual bone resorption there by leading to failure.

14. MECHANISM OF OSSEOINTEGRATION • Healing process may be primary bone healing or secondary bone healing. • In primary bone healing , there is well organized bone formation with minimal granulation tissue formation - ideal • Secondary bone healing may have granulation tissue formation and infection at the site, prolonging healing period. ( Fibrocartilage is sometimes formed instead of bone – undesirable)

15. BIOLOGICAL PROCESS OF INTEGRATION(BRANEMARK)

16. STAGES OF OSSEOINTEGRATION According to Misch , there are two stages in osseointegration , Each stage been again divided into two substages .

17. SURFACE MODELING (Stage1 and 2) REMODELLING AND MATURATION(Stage 3 and 4)

18. Stage 1: Woven callus Woven bone is formed at implant site. Primitive type of bone tissue and characterized Random, felt-like orientation of collagen fibrils Numerous irregularly shaped osteocytes Relatively low mineral density

19. Stage 2: Lamellar compaction The woven callus matures as it is replaced by lamellar bone. This stage helps in achieving sufficient strength for loading.

20. Stage 3: Interface remodeling This stage begins at the same time when woven callus is completing lamellar compaction. During this stage callus starts to resorb , and remodeling of devitalized interface begins. The interface remodeling helps in establishing a viable interface between the implant and original bone.

21. Stage 4: Compact bone maturation During this stage compact bone matures by series of modeling and remodeling processes. The callus volume is decreased and interface remodeling continues.

22. BONE TISSUE RESPONSE Osborn and Newesley (1980) : Proposed 2 different phenomena Distance Osteogenesis : A gradual process of bone healing inward from the edge of the osteotomy toward the implant. Bone does not grow directly on the implant surface.

23. Contact Osteogenesis The direct migration of bone-building cells through the clot matrix to the implant surface. Bone is quickly formed directly on the implant surface.

24. FACTORS THAT INFLUENCE OSSEOINTEGRATION

25. IMPLANT RELATED FACTORS Implant Biomaterial(Biocompatibility) Implant Biomechanics Implant Design Implant Taper Apical Design Implant Width Crest module design Implant Surface Topography(Surface roughness) Implant Surface Modifications Contamination Heat Production Implant Loading

26. SURGICAL FACTORS THAT AFFECT OSSEOINTEGRATION

27. PATIENT FACTORS

28. METHODS OF EVALUATION OF OSSEOINTEGRATION

29. OTHER METHODS TO ASSESS  OSSEOINTEGRATION   Cone beam CT Periotest Dynamic model testing Impulse testing 

30. FAILURES OF OSSEOINTEGRATION

31. Revised Albrektsson Success Criteria Int J Oral Maxillofac Implants.  1986 Summer;1(1):11-25. The long-term efficacy of currently used dental implants: a review and proposed criteria of success. Albrektsson T ,  Zarb G ,  Worthington P ,  Eriksson AR .

32. OSSEOPERCEPTION Osseoperception is defined as mechanoreception in the absence of a functional periodontal mechanoreceptive input but derived from temporomandibular joint (TMJ)

33. CONCLUSION The “ osseointegration ” is a multifactorial entity. Achieving the osseointegration of the endosteal dental implants needs understanding of the many clinical parameters. Thorough understanding and application of factors affecting the osseointegration and biological process of osseointegration in clinical practice is the key factor for success.

34. REFERENCES Hobo, Ichida, Garcia “ Osseointegration and occlusal rehabilitation” Quintessence Publishing. Jan Lindhe “Clinical periodontology and implant dentistry” 4 th edition, Blackwell Publishing. Elaine McClarence “ Branemark and the development of osseointegration ” Quintessence publication Carl E. Misch “Implant dentistry” 2 nd edition, Mosby.

35. Charles M.Weis “Principles and practice of implant dentistry” Mosby. Per Ingvar Branemark “ Osseointegration and its experimental background” JPD 1983 Vol. 50, 399-410. Hanson, Alberktson “Structural aspects of the interface between tissue and titanium implants” JPD 1983 vol. 50, 108-113.

36. T. Alberktson “ Osseointegrated dental implants” DCNA Vol. 30, Jan 1986, 151-189. Richard Palmer “Introduction to dental implants” BDJ, Vol. 187, 1999, 127-132. Geroge A. Zarb “ Osseointegrated dental implants: Preliminary report on a replication study”. JPD 1983, Vol 50, 271-276. Bergman “Evaluation of the results of treatment with osseointegrated implants by the Swedish National Board of Health and Welfare”. JPD 1983, vol. 50, 114-116.

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