Implant Dentistry
Loma Linda University
Implant Dentistry
OSSEOINTEGRATION
Loma Linda University
Implant Dentistry
Concepts of the Interface
Clinical Applications
Loma Linda University
Implant Dentistry
Prof. Per-Ingvar Brånemark In 1952, Prof. Per-Ingvar Brånemark of Sweden conducted an experiment where he utilized a titanium implant chamber to study blood flow in rabbit bone. At the conclusion of the experiment, when it became time to remove the titanium chambers from the bone, he discovered that the bone had integrated so completely with the implant that the chamber could not be removed. Brånemark called the discovery “Osseointegration”
Loma Linda University
Implant Dentistry
OSSEOINTEGRATION Osseointegration is a biological concept.
PI. Branemark
Loma Linda University
"Direct structural connection between ordered, living bone and the surface of the load-carrying implant"
Implant Dentistry
OSSEOINTEGRATION In May of 1982, George Zarb, a Professor from Toronto University, organized the Toronto Conference on Osseointegration in Clinical Dentistry.
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Implant Dentistry
OSSEOINTEGRATION
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Implant Dentistry
1976-1982
Loma Linda University
Implant Dentistry
Ligament Fibro-integration Capsule Connective Tissue Interface
Loma Linda University
Implant Dentistry
John Brunski J Dent Res 1979
Loma Linda University
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.
Loma Linda University
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.
Loma Linda University
Implant Dentistry
A 15-year study of osseointegrated implants in the treatment of the edentulous jaw.
Adell R, Lekholm U, Rockler B, Br책nemark PI. Int J Oral Surg. 1981 Dec;10(6):387-416.
Loma Linda University
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.
Adell R, Lekholm U, Rockler B, Br책nemark PI. Int J Oral Surg. 1981 Dec;10(6):387-416.
Loma Linda University
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.
Adell R, Lekholm U, Rockler B, Br책nemark PI. Int J Oral Surg. 1981 Dec;10(6):387-416.
Loma Linda University
Implant Dentistry
Loma Linda University
Implant Dentistry
http://www.cda.org/page/Library/cda_member/pubs/journal/jour1101/history
Loma Linda University
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)
Loma Linda University
Implant Dentistry
Titanium • 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.
Loma Linda University Machined TPS
HA
Grit-Blast
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.
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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
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Implant Dentistry
Biology of Osseointegration Woven Callus 6w Lamellar Compaction 18w Interface Remodeling 18w
Roberts, E.W. Bone Tissue Interface J Dent Ed 1988
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Compacta Maturation 54w
Implant Dentistry
Following initial placement, 0.5mm bone next to implant will become necrotic. Ingrowths of vascular loops will occur at the rate of 0.5mm per day. (Woven Callus) Remodeling phase with hematopoietic-derived osteoclastic cells form cutting cones that will remove the established woven matrix. (40Âľm per day) Following resorptive cutting cones, an osteogenic front of lamellar differentiation occurs.
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Implant Dentistry
Scanning electron micrograph showing a bone cell attaching to titanium
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Implant Dentistry
Three to four months post-insertion.
Bone implant interface 25% to 75%
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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.
Loma Linda University
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.
Loma Linda University
Implant Dentistry Effect of Poor Bone Quality #Implants Type 1-3 Bone
Engquist '88 van S.ghe '90 Jaffin '91 Johns '92 Fugazzotto '93 Smedberg '93
141 491 952 453 851 53
% Failure relative to # Implants placed 2,938
Failures (%)
Failures (%)
15 19 29 16 12 0
198 67 102 57 512 33
52 4 36 16 22 12
91 (3)
969
143 (15)
97%
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Type 4 Bone
85%
Implant Dentistry
Surface and Design
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Implant Dentistry
Implant macro-retentive features. Screw threads Solid body press-fit Sintered bead surface
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Implant Dentistry
Implant micro-retentive features. Surface Roughness Macroscopic Microscopic
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Implant Dentistry
Implant micro-retentive features. Surface Roughness Additive Methods (TPS-HA) Subtractive Methods (SLA, Ti Oxide)
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Implant Dentistry
Hydroxyapatite Surfaces Loma Linda University
Implant Dentistry
Loma Linda University
Implant Dentistry
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Classification of cell attachment Rajaraman et al 1974 Stage I. Initial contact with surface & anchorage via filapodia
Implant Dentistry
I.
II .
II I.
IV .
Stage II. cells with lamellipodia Stage III. circumferential spreading Stage IV. full spreading & flattening
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Turned Implants
a. stage 1
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Implant Dentistry
b. stages 1, 2, 3
Implant Dentistry
An implant surface has an optimal balance between pore size on the surface (pore sizes of 1-5µm diameter and 15µm in depth) which optimizes the shear strength of the individual bone In-growth into anyone pit with the need to have as many “pits” on the surface as possible.
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Implant Dentistry
Mechanisms of bone healing around surface treated dental implants
distance osteogenesis: no bone bonding onto surface
contact osteogenesis: de novo bone formation Â
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Implant Dentistry
Loma Linda University
source: A. Piattelli
Implant Dentistry
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 Â
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Overview
Implant Dentistry
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.
Loma Linda University
Overview
Implant Dentistry
Bone remodeling: Creation of bone-implant interface comprising de novo bone formation Â
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Overview
Implant Dentistry
Loma Linda University
Implant Dentistry
Smooth VS Surface Treatment
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Implant Dentistry
Smooth VS Surface Treatment
Loma Linda University
Implant Dentistry
Increased Attachment Strength 300
Ncm
200
100
Ti Alloy
CP Ti
HA
CARR et al: JOMI 1995
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Implant Dentistry
JHONSON B. HA COATED IMPLANTS. LONG TERM CONSEQUENCES. JCDA 1992
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Implant Dentistry
tanium
HA Coated Surface
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Current Designs
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Implant Dentistry
Implant Dentistry
Loma Linda University
Implant Dentistry
80â&#x20AC;&#x2122;s 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)
Loma Linda University
Implant Dentistry
Oxidized
Machined
12 w
Dr. Glauser, Switzerland
Loma Linda University
Implant Dentistry
Machined
coronal apical total 31.6 %
Oxidized
29.9 % 33.3 %
coronal apical total
% Bone-to-metal contact
Loma Linda University
42.3 % 72.1 % 57.5 %
Implant Dentistry
Immediate loading posterior maxilla
Loma Linda University
Dr. Glauser, Switzerland
Implant Dentistry
Immediate loading posterior maxilla 7500
RFA (mean value)
[Hz]
7000
oxidated
nss
machined
nss
6500
* * *
6000
5500
5000
0 1w 1m
Loma Linda University Applied Osseointegration Research 2001
2m
3m
6m
Implant Dentistry
Immediate Loading
Loma Linda University