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Osseointegration  - dental implants training by Indian dental academy /certified fixed orthodontic courses by Indian dental academy
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Osseointegration - dental implants training by Indian dental academy /certified fixed orthodontic courses by Indian dental academy

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Welcome to Indian Dental Academy
The Indian Dental Academy is the Leader in continuing dental education , training dentists in all aspects of dentistry and offering a wide range of dental certified courses in different formats.


Indian dental academy has a unique training program & curriculum that provides students with exceptional clinical skills and enabling them to return to their office with high level confidence and start treating patients

State of the art comprehensive training-Faculty of world wide repute &Very affordable

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Osseointegration  - dental implants training by Indian dental academy /certified fixed orthodontic courses by Indian dental academy Osseointegration - dental implants training by Indian dental academy /certified fixed orthodontic courses by Indian dental academy Presentation Transcript

  • OSSEOINTEGRATION -- DENTAL IMPLANTS INDIAN DENTAL ACADEMY Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com
  • CONTENTS: • • • • • • • • • • • INTRODUCTION. DEFINITION. HISTORICAL REVIEW. NORMAL BONE STRUCTURE AND PHYSIOLOGY. BIOLOGICAL PROCESS OF OSSEOINTEGRATION. BIOLOGICAL ATTACHMENT OF OSSEOINTEGRATION. THERIES OF OSSEOINTEGRATION. FACTORS INFLUENCING OSSEOINTEGRATION. REVIEW OF LITERATURE. FUTURE CONCEPTS OF OSSEOINTEGRATION. CONCLUSION. www.indiandentalacademy.com
  • INTRODUCTION • The ideal goal of modern dentistry is to restore the normal function, form, and esthetics of oral structures. • Implant dentistry is unique because of its ability to achieve this goal. • The word osseointegration consists of “OS” the Latin word for bone and “integration” derived from Latin word meaning the state of being combined into a complete whole. www.indiandentalacademy.com
  • DEFINITION • “Direct structural and functional connection between ordered, living bone and surface of a load carrying implant”. -- Brane mark 1956. • A time dependent healing process whereby clinically asymptomatic rigid fixation of alloplastic materials is achieved, and maintained, in bone during functional www.indiandentalacademy.com loading.-- Zarb 1991.
  • HISTORICAL REVIEW • Dr. Per-Ingvar Branemark- 1956 • Professor at the institute for Applied Biotechnology, University of Goteborg. www.indiandentalacademy.com
  • • Initial concept of osseointegration stemmed from vital microscopic studies of microcirculation in bone repair mechanisms. Titanium chamber surgically inserted into tibia of rabbit www.indiandentalacademy.com
  • EXPERIMENTS ON DOGS TIBIA Dog tibia with titanium stabilizer Reconstructed tibia 3 years latter www.indiandentalacademy.com Integrated titanium screws
  • EXPERIMENTS ON DOGS MANDIBLE Segmental defect of dog mandible reconstructed with titanium plate Reconstructed area 6 months later www.indiandentalacademy.com
  • Formation of bone around implants Indentation of implant on bone Scanning electron micrograph after 9 months. www.indiandentalacademy.com
  • BONE PHYSIOLOGY AND STRUCTURE www.indiandentalacademy.com
  • Bone is Continuously Remodeling www.indiandentalacademy.com
  • BIOLOGICAL PROCESS OFOSSEOINTEGRATION • OSTEOPHYLIC PHASE. • OSTEOCONDUCTIVE PHASE. • OSTEOADAPTIVE PHASE. www.indiandentalacademy.com
  • OSTEOPHYLIC PHASE: • • • • • Blood clot formation. Inflammatory cells infiltration. Neovascularisation – 3rd day. Ossification begins during first week. This phase lasts about one month. www.indiandentalacademy.com
  • OSTEOCONDUCTIVE PHASE: • Woven bone – foot plate. • Lamellar bone formation. • Lasts for 4 months. osteoblasts Neovascularization Callus www.indiandentalacademy.com
  • OSTEO ADAPTIVEPHASE: • A balanced remodeling occurred. Remodeling bone • The foot plate/ woven bone thickened in response to the load transmitted through the implant. • Some reorientation of vascular pattern may be seen. www.indiandentalacademy.com
  • www.indiandentalacademy.com
  • BONE FORMATION AROUND IMPLANT: • OSTEOGENESIS: Formation of new bone from osteocompetent cells. • OSTEOCONDUCTION: Formation of bone along scaffold from hosts osteocompetent cells. • OSTEOINDUCTION: Formation of new bone from the differentiation and stimulation of mesenchymal cells by bone inductive proteins. www.indiandentalacademy.com
  • BIOLOGICAL ATTACHMENT OSSEOINTEGRATION GINGIVA-TITANIUM OXIDE CONTACT ZONE. Hemidesmosome like structures anchoring the epithelial cells to the implant surface www.indiandentalacademy.com
  • SUBGINGIVAL CONNECTIVE TISSUE – TITANIUM CONTACT ZONE. fibroblast www.indiandentalacademy.com
  • INTERFACE BETWEEN CORTICAL BONE AND TITANIUM. Osteocyte www.indiandentalacademy.com
  • INTERFACE BETWEEN CANCELLOUS BONE AND IMPLANT Osteoblastic processes Fibroblastic processes www.indiandentalacademy.com
  • THEORIES OF OSSEOINTEGRATION • BIOMECHANICAL BOND • Branemark, Zarb, Albrektsson, 1985. www.indiandentalacademy.com
  • VAN DER WALLS BONDING www.indiandentalacademy.com
  • HYDROGEN BONDING www.indiandentalacademy.com
  • CHEMICAL BOND www.indiandentalacademy.com
  • CHEMICAL PROCESSES THAT CAN TAKE PLACE AT THE INTERFACE AT A MOLECULAR SCALE www.indiandentalacademy.com
  • CHEMICAL BOND-BIOINTEGRATION • Sul etal – 2002. • Electrostatic ion bonding of calcium ions with polyanioinic molecules of bone matrix proteins will occur. • The calcium cations will stimulate particular surface receptors and trigger further recruitment of osteoprogenitor cells and osteoblasts through calcium signaling pathway. www.indiandentalacademy.com
  • The neuromuscular system as it relates to the osseointegrated implant • A fixture site does not have periodontal ligament but has nerve endings located near the fixture, sensing pain and temperature. • As the periodontal ligament is lost the fixture remains with reduce amount of receptors. • Impulses from the fixture sites are transmitted through nucleus of trigeminal nerve. www.indiandentalacademy.com
  • FACTORS INFLUENCING THE OSSEOINTEGRATION • • • • • • • • • BIOCOMPATIBILITY BIOMECHANICS. IMPLANT DESIGN. SURFACE ROUGHNESS OF IMPLANT. SURFACE MODIFICATION OF IMPLANT. HEAT PRODUCTION DURING OSTEOTOMY. CONTAMINATION. PRIMARY STABILITY OR INITIAL STABILITY LOADING www.indiandentalacademy.com
  • BIOCOMPATIBILITY • Biocompatibility has been defined as the capacity of a material to exist in harmony with the surrounding biologic environment; not having toxic or injurious effects on biologic functions. • Key factors that influence the benefits and maintenance of biocompatibility: • Corrosion resistance. • Cytotoxicity of corrosion products. • Metal contamination. www.indiandentalacademy.com
  • BIOMECHANICS IN IMPLANTS • Compressive forces attempt to push masses towards each other. • Tensile forces pull objects apart. • Shear forces on implants cause sliding. www.indiandentalacademy.com
  • IMPLANT DESIGN • A smooth cylinder implant body results in essentially a shear type of force at the implant-to-bone interface. www.indiandentalacademy.com
  • Threaded implants: • • • • More surface area. Maximum initial bone contact. Facilitate dissipation of stresses at bone -implant interface. Rigidly fixed initially to limit micro movement during healing. www.indiandentalacademy.com
  • THREAD PITCH: • The number of threads per unit length. • The finer the pitch, the more threads on implant body for a given unit length. • The greater the number of threads, the greater the functional surface area. www.indiandentalacademy.com
  • THREAD SHAPE: • The shear force on a Vthread face is about 10 times greater than the shear force on a square thread. www.indiandentalacademy.com
  • THREAD DEPTH: • Is the distance between the minor diameter and major diameter of implant. • The deeper the thread depth, functional surface of the implant body. www.indiandentalacademy.com
  • IMPLANT TAPER: • A smooth sided tapered implant allows for a component of compressive load to be delivered to the bone-to-implant interface, depending on degree of taper. • The larger the taper, the greater the component of compressive load delivered to the interface. • The amount of taper cannot be greater than 30°. • Tapering of threaded implant has no advantage. www.indiandentalacademy.com
  • APICAL DESIGN OF IMPLANT: • Round cross cross sections at apex of implant do not resist torsional or shear forces when abutment screws tightened. • As a result, an anti rotational features are incorporated, usually in the apical region of implant body, with a hole or vent being the most common design. • Another antirotational features are flat sides or grooves at apical region. www.indiandentalacademy.com
  • IMPLANT WIDTH: • Most implants falls with in the range of 3.5 to 6 mm. • Increased implant width adequately increases the area over which occlusal forces may be dissipated. www.indiandentalacademy.com
  • LENGTH OF IMPLANT: • Most common lengths are between 8 to 15 mm. • As the length of implant increases, the total surface area increases. • Within anatomical limitation it is good practice to use the longest implant. www.indiandentalacademy.com
  • CREST MODULE DESIGN: • A smooth parallel, sided crest module will result in shear stresses. • An angled crest module of more than 20° will impose beneficial compressive component. • Crest module of an implant should be slightly larger than the outer thread diameter. • Thus the crest module seats fully over the implant body osteotomy, providing a deterrent for ingress of bacteria. www.indiandentalacademy.com
  • SURFACE ROUGHNESS OF IMPLANT • Moderately rough implants developed the best bone fixation – Wennerberg, 1996. www.indiandentalacademy.com
  • IMPLANT SURFACE MODIFICATION NEED FOR SURFACE MODIFICATION: • To increase surface area. • To remove surface contaminants. • To bring better bonding. • To increase surface roughness of metal. • To increase corrosion resistance of metal. • To make the metal more passive. www.indiandentalacademy.com
  • TECHNIQUES OF SURFACE MODICATION OF TITANIUM: GRIT BLASTING: • 250 µm diameter Al₂O₃ particles for 6 seconds at o.8 Mpa pressure. • It provides a defined roughness. • Micro-retentive surface pores are formed ACID ITCHING: • Done in a solution of Hcl at 40⁰c. • The resulting surface textures, ranging in dimension from 1µm to 50µm micro retentive pits. www.indiandentalacademy.com
  • ANODIC OXIDATION: • An electrochemical method of treatment. • The sample is placed in an electrolyte bath, and a potential is applied, a current will flow through the electrolyte due to ion transport. • The transport of oxygen ions through the electrolyte builds up a passivating oxide layer on the surface of sample. www.indiandentalacademy.com
  • PLASMA OXIDATION: • An oxygen plasma is used instead of liquid electrolyte. • Plasma oxidation is a cleaner method than anodic oxidation. • Increased surface cleanliness usually results in an increase in surface energy. • Increases surface area of bone-to-implant interface. • Stimulate osteogenesis. • Resist shear forces and improve load transfer. www.indiandentalacademy.com
  • HYDROXYAPETITE COATING: Advantages: • Faster healing bone interface. • Enhances gap healing. • Stronger interface. • Less corrosion of metal. Disadvantages: • Flaking, cracking on insertion. • Increased plaque retention when above bone. • Increased bacteria and nidus for infection. • Increased cost. www.indiandentalacademy.com
  • CONTAMINATION: www.indiandentalacademy.com
  • HEAT PRODUCTION DURING OSTEOTOMY: • Heating of bone to a temperature in excess of 47°C during implant surgery can result in cell death and denaturation of collagen. • As a result, osseointegration may not occur, instead the implant becomes surrounded by a fibrous capsule. www.indiandentalacademy.com
  • LOADING • Minimum integration time: Region of implant time Minimum Anterior mandible – 3 months Posterior mandible – 4 months Anterior maxilla – 6 months Posterior maxillary – 6 months Bone graft – 6-9 mon www.indiandentalacademy.com
  • PATIENT FACTORS: • • • • • • • • • • • • Age. Compromised oral hygiene. Heavy smoking. Anemia. Vitamin-c deficiency. Uncontrolled periodontal disease. Psychological problem. Uncontrolled diabetes. Radiation treatment. Chemotherapy. Bone density. Available bone www.indiandentalacademy.com
  • BONE DENSITY: CLASSIFICATION: Misch in 1988. • D1 bone is primarily dense cortical bone. • D2 dense to thick cortical bone on the crest and coarse trabecular bone underneath. • D3 bone has thinner porous cortical crest and fine trabecular bone within. • D4 bone has almost no crestal cortical bone. www.indiandentalacademy.com
  • • Increased bone density – provides mechanical immobilization of implant and also permits distribution and transmission of stresses. www.indiandentalacademy.com
  • REVIEW OF LITERATURE www.indiandentalacademy.com
  • IJOMI 2007;22:533-551. •T-CAM, Tetra cell adhesion molecules enhanced the differentiation of osteoblast like cells. •T-CAM coating significantly enhanced the peri implant bone formation in rabbit femur. www.indiandentalacademy.com
  • •Phosphated titanium has the potential to accelerate implant osseointegration by increased TGF-b1 production. •EMD did not accelerate osteoblast function www.indiandentalacademy.com
  • • Three different surfaces were evaluated. A machined surface (Ti-M), was consider as control. • The second surface was acid itched Ti-AE. • Third surface was prepared by exposing Ti-AE to NaOH solution. • Third surface exhibited greater efficiency for enhancing cell differentiation, and in turn, may speed up the process of osseointegration www.indiandentalacademy.com
  • FUTURE CONCEPTS OF OSSEOINTEGRATION www.indiandentalacademy.com
  • Combining the concept of biomimetics and dental implants may change the world of implant dentistry as we know it today. BMP’s may act as growth and differentiation factors and as chemotactic agents. They stimulate angiogenesis, migration, proliferation and differentiation of stem cells from the surrounding mesenchymal tissues into bone forming cells in an area of injury. Coating implants with BMP’s may also accelerate initial healing time during integration of the dental implant, thereby reducing overall treatment times and improving overall success rate. www.indiandentalacademy.com
  • Research and development in this field will require attention to three main aspects. 1.Selecting the appropriate surface texture. 2.Developing efficient carrier vehicles or surface precoating agents for initial retention of the biomimetic substances and their controlled release. 3. Identifying appropriate biomimetic agents. www.indiandentalacademy.com
  • INTEGRINS – Receptor proteins which permit cells to bind & respond to the extracellular matrix. www.indiandentalacademy.com
  • BENEFITS • Same-Day Teeth. • Eliminates discomfort during a long healing period. • Fixtures are inserted in the morning and the final prosthesis is anchored in the afternoon. • No rejection www.indiandentalacademy.com
  • OSSEOPERCEPTION : The interaction between the osseointegrated fixture bone tissue, receptor systems and nervous system has to be studied. www.indiandentalacademy.com
  • CONCLUSION: # THOROUGH UNDERSTANDING AND APPLICATION OF FACTORS AFFECTING THE OSSEOINTEGRATION AND BIOLOGICAL PROCESS OF OSSEOINTEGRATION IN CLINICAL PRACTICE IS THE KEY FACTOR FOR SUCCESS.# www.indiandentalacademy.com
  • REFERENCES • Dental implants in Prosthodontics – Carl E.Misch. • Textbook of Dental Implants – Weiss. • Textbook of Periodontology – Langden. • Textbook of implantology -- Branemark. www.indiandentalacademy.com
  • ACKNOWLEDGEMENT • • • • • • • • Dr. L. Krishna Prasad – Professor & Head. Dr. P. Srinivas chakravarthy Dr. K. Naga Neelima Devi Dr. M. Sridhar Dr. Suprakash Dr. Ram Kumar. Dr. Sumanth Krishna. Dr. Raja Satish. www.indiandentalacademy.com
  • THANK U Leader in continuing dental education www.indiandentalacademy.com www.indiandentalacademy.com