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Osteointegration_of_Implant.pptx
1. Osteointegration
of Implant
Guided by Submitted by
Dr. Gopinath Vivekanandan
Dr. Akhilesh Tomar
Dr. Narender Yadav Gourav Sriwastva
Dr. Deepak BDS Intern
Dr. Sonali
2. CONTENT 1. Introduction
2. Why Implant?
3. History of Implant
4. Macrodesigns of Implant
5. Types of Implant
6. Tooth vs Implant
7. What is Osteointegration?
8. Mechanism of Osteointegration
9. Biological Attachment vs Biological process of
Integration
10. Bone to Implant Interface
11. Bone tissue response to Implant
12. Factors affecting osteointegration
13. What NEXT?
14. References
3. Introduction
A dental implant is a device that is installed into the
jawbone to retain a prosthesis.
It is an alloplastic substance.
Also known as
“ENDOOSSEOUS FIXTURE”
4. Why Implant ?
1. To replace an edentulous area.
2. To correct poor oral muscular
coordination.
3. To enhance Esthetics.
4. To improve the successs rate of
prosthesis.
5. To reduce the removal of prosthesis size.
Implant Supported replacement teeth
look,feel & function like natural
teeth.
6. Macrodesigns
of Implant
1.Endosseous Implant
- Blade like
- Pins
- Root form,Cylindrical(hollow and full)
- Disk like
- Screw shaped
- Tapered and Screw Shaped
2. Subperiosteal (Custom frame) implant
3. Transmandibular Implants.
7.
8. Types of Implant
Implant on the basis of time and placement
can be classified as 3 types :-
● Immediate implant
● Delayed implant
● Immediate loading implant
10. Delayed
Implant
The implant is placed at 3-6 months after extraction.
Provide adequate time for healing of extraction socket and
formation of adequate bone.
11. Immediate
Loading Implant ● Implant is placed at the same time of extraction and
loading is done within 48 hours of implant
placement.
● They don’t depend much on OSTEOINTEGRATION.
12. Tooth vs Implant
Tooth Implant
1. Attached by- Cementum-
PDL-Bone
1. Attached by
Osteointegration
2. 13 groups of fibers are
present Perpendicular to
tooth surface
2. 2 groups of fibers
● Parallel
● Circular
-Not attached to implant
surface and Bone
-Functional ankylosis is
the key to attachment.
13. Tooth vs Implant
Tooth Implant
3. Biological width
JE (0.97)+CT(1.07)=2.04mm
3. Biological width 3.08mm
4. Vascularity is more. 4. Vascularity is less.
5. Probing depth is around 3mm. 5. Probing depth is more 2.5 - 5 mm
15. Osteogenesis Refers to the formation or development
of new bone by cells contained in the
graft.
16. Osteoinduction It is a chemical process by which
molecules contained in the graft (e.g.-
bone morphogenetic proteins) convert the
neighboring cells into osteoblasts,which
in turn form bone.
Osteoinduction is defined as the process
by which osteogenesis (i.e., new bone
formation from osteocompetent cells in
connective tissue or cartilage) is induced.
17. Osteoconduction It is a physical effect by which the
matrix of the graft forms a scaffold
that favours outside cells to penetrate
the graft & form new bone.
Scaffolds are three-dimensional (3D) porous,
fibrous or permeable biomaterials intended to
permit transport of body liquids and gases,
promote cell interaction, viability and
extracellular matrix (ECM) deposition with
minimum inflammation and toxicity while bio-
degrading at a certain controlled rate.
18.
19. Osteointegration
Derived from “Osteon “
Greek word meaning Bone
& Latin word “Integron”
meaning To make Whole
which is Integrated.
● Branemark et al (1977,1985) coined
the term “OSTEOINTEGRATION” to
describe a direct structural and
functional connection between
ordered living bone & the surface of
a load-bearing implant.
● A layer of connective tissue and
downgrowth of oral epithelium
(Pseudo Periodontal Ligament)
gradually separated the implant from
the bone.
20. Contd.
Schroeder et al (1991,1996) referred Osteointegration to the
integration phenomenon as a functional ankylosis .
Alberktsson and Zarb (1993) referred Osteointegration as a process
whereby clinically asymptomatic rigid fixation is achieved and
maintained in bone during functional loading.
21.
22. Mechanism of
Osteointegration
It may occur through 2 ways
1. Primarry Bone Healing
2. Secondary Bone Healing
In Primary Bone healing there is well
organized bone formation with
minimal granulation tissue formation.-
--- IDEAL
In Secondary Bone Healing may have
granulation tissue formation and
infection at the site prolonging
healing period because fibrocartilage
is formed instead of bone-------
NOT DESIRABLE
23. Contd.
● If the space between an implant and its osseous bed is
narrow,bone formation is comparable to Primary healing after a
bone fracture,because no callus is formed .
Direct bridging via lamellar bone occurs, at a rate of about
1μm/day.
● Healing of Implant with a wide space is comparable to secondary
healing of a bone fracture, as bone formation occurs via
formation of fibrous and bony callus, at about 50-100 μm/day.
The temporal sequence is woven bone with subsequent remodelling
into lamellar bone.
24. Contd.
● During preparation of Implant bed, periosteal intracortical and
endosteal blood vessels are damaged. As a result blood
accumulates in peri implant space, with a loose attachment of
fibrin on the surfaces of both bone and implant.
● This hematoma will be remodeled by proliferating tissue with new
capillaries and fibrous collagen connective tissue in 7-14 days.
● New bone formation can occurs directly in the vicinity of the
implant depending upon the degree of its stability.
25. Contd.
● Implant instability influences cell differentiation and therefore also
bone formation.So the implant stability is an absolute requirement for
all types of implants with adequate blood supply.
● Bony remodelling of the callus is completed after 4-6 weeks, through
activation of the haversian system , numerous resorption canals are
formed and the remodelling process into lamellar bone begins.
● These mineralization processes, which transform the osteoid into
calcified osseous substance, proceed at about 1 μm/day.
26. Different Phases
of Healing Osseous Healing - Early Phase
● Preceeded by Hemorrhage and
formation of a blood clot,this
coagulum consists of fibrin and
embedded blood cells and represent
the scaffold for reparative tissue.
● The coagulum begins to organize
with ingrowth of capillaries and
preosteoblasts (Centripetal bone
growth).
27. Contd.
● During this early phase, in addition to new bone formation,the
macrophages as well as multinucleated giant cells appear and
recognize the implant as foreign body.
● As bone formation is initiated at the implant surface, the number
of multinucleated giant cells is reduced.
28. Osseous Healing - Late Stage
● Depending upon the width of the gap
between the implant surface and the
osseous bed,direct filling of the
space can occur about 0.2mm by
means of concentric bony apposition.
● Wider space will usually be filled
within 14 days by a network of new
woven bone will be remodelled by
lamellar bone in about 2 months.
29. Contd.
● Direct bony contact with implant surface ranges from
● 56-85% with Screw type implant.
● 46-82% with Blade type implant.
AREA OF IMPLANT SURFACE NOT COVERED WITH BONE
MANIFEST ADIPOSE TISSUE CELLS WITHOUT AN INTERVENING
FIBROUS LAYER.
30. Biological
Attachment vs
Biological
process of
Integration
Biological attachment : New connection
of connective tissue with the formerly
pathologically exposed root surface, i.e.,
formation of new cementum with inserted
periodontal ligament fibers (also,
formation of new bone with Sharpey's
fibers embedded).
33. Bone to
Implant
Interface
This can be described by 2 theories.
1. Osseointegration - given by
Branemark 1985
2. Fibro-osseous integration - given
by Linkow 1976, James 1985,
Weiss 1986
34. Fibro- osseous
Integration
Tissue to implant contact with dense
collagenous tissue between the implant
and bone.
● Seen in early implant system
● Initially good success rate but
extremely poor long term success
rate .
● It is considered as a failure as of
now.
35. Contd.
● Presence of connective tissue between implant and bone.
● Collagen fibers functions similarly to Sharpey’s fiber.
● The fibers are arranged haphazardly, parallel to the implant
surface.
● When forces are applied they are not transmitted through fibers.
36. Why Fibrosseous Implant Failed?
● Remodelling was absent as forces are not transmitted through
fibers.
● Forces applied resulting in widening of fibrous encapsulation,
inflammation and gradual bone loss.
● No such clinical research and evidence is available.
37. Osseointegration Osseointegration (from Latin osseus "bony"
and integrare "to make whole")
It is the direct structural and functional
connection between living bone and the
surface of a load-bearing artificial
implant ("load-bearing" as defined by
Albrektsson et al. in 1981).
38. Bone Tissue
Response to
Implant
The mechanism and
biological process of the
foreign body response (FBR)
induced by most of the
implants include four stages:
1.protein adsorption
2.acute inflammation
3.chronic inflammation
4. collagen encapsulation
(fibrosis).
44. References
1. Carranza’s Clinical Periodontology & Implant
Dentistry -6th edition
2. Periodontics, medicine, surgery & Implant -
Rose,Mealey,Genco,Cohen
3. Clinical Periodontology & Implant Dentistry -
Jan Lindhe 6th edition
4. Marlin Medical Asssistance
5. A ‘Graft Less’ Approach to Posterior
Implant Sites -Dr. Craig M. Misch
6. Dealing with the Foreign-Body Response to
Implanted Biomaterials: Strategies and
Applications of New Materials Donghui
Zhang, Qi Chen, Chao Shi, Minzhang Chen,
Kaiqian Ma, Jianglin Wan, and Runhui Liu*
45. 7.Osseointegration & Dental Implant -
Asbjorn Jokstand.
8. Risk factors associated with dental
implant failure - A study of 302
implants placed in a Regional center-
Mehmet Oztel,Wojciech M. Bilski,
Arthur Bilski- The journal of
Contemporary Dental Practice ,
Aug,2017
9.Implant Dentistry, research, guide,
Basic translation and clinical Research-
Ahmed M Ballo.
