14. •Branemark & Coworkers at
the university of Goteberg
in late 1950’s
• Branemark et al 1969 ----- Animal
experiments
•Branemark et al 1977 ----- First
clinical report
16. • SCHROEDER in mid 1970’s was
the first investigator to demonstrate
osseointegration
17. Direct connection between bone and
implant without interposed soft
tissue layers
100% bone connection to implant
does NOT occur
18. At light microscopic level,
Intimate bone-implant
Contact has been reported
Schenk & Buser 1998
19. Linder et al 1983
An ultra thin amorphous
Layer of proteoglycan exists between
The implant surface and bone with no
Interposed fibrous tissue
Osseointegration at Ultrastructural level
Thomsen et al 1985
Some interposition may be
present between the bone-implant
interface
20.
21. Osseointegration is a time related
phenomenon
• Johansson & Albrektsson 1987
• Yamanaka et al 1992
22. Johansson & Albrektsson 1987
•1 month following implant insertion:
Fibrous tissue interface
•3 months:
50 % implant to bone interface
•6 months :
65% implant to bone Interface
•1 year:
85% implant to bone interface
27. Weiss et al 1986, 1987
Peri-implant membrane with an osteogenic
effect
Collagen fibers invest the implant surface
Function ------ Tension and Compression
Piezoelectric effect
29. Relative movement during healing phase
If the implant moves relative to its
surrounding bone during healing phase
---- Fibroosseous integration
If the implant is allowed to heal
without relative movement -----
Osseointegration
30. •Implant should be placed in full
function within 1 or 2 months
Weiss 1987
•Afunctional submerged implant
results in:
•Osseointegration
•Retarded healing
•Failure
31. Branemark 1985
Implant must be protected and
should remain completely out of
function for 3 – 6 months
Healing phase of 12 months
Remodeling phase of 3 – 18 months
Steady state after 18 months
32. Load bearing by osseointegration is
Preferred due better load distribution
And also greater loads can be
accommodated
Fibroosseous integration is preferred
Due to dampening effect during
dynamic loading
34. Failure of Osseointegration
• Premature loading
• Migration of junctional epithelium in
the interface
• Placing the implant with pressure –
Wertman 1986; Weiss 1987
• Overheating of bone
• Improper fit of implant
49. Albrektsson et al 1991:
– Biocompatibility
– Design
– Surface condition of implant
– Status of the host bed
– Surgical technique at insertion
– Loading conditions applied
afterwards
51. Biocompatibility refers to the
ability of a material to perform
with an appropriate response in a
specific application
Does not refer to total inertness
of the material
Biocompatibility is affected by
intrinsic nature of the material,
as well as design of the implant
54. • Strength of implant
• Type of bone
• H/O implant failure in the area of
interest
• Implant design
• Surface finish
55. ADA Guidelines for Implant
Biomaterials
• Evaluate the physical properties that
ensure sufficient strength
• Demonstration of ease of fabrication
and sterilization without material
degradation
56. ADA Guidelines for Implant
Biomaterials
• Biocompatibility evaluation including
cytotoxicity testing
• A minimum of two clinical trials, each
with a minimum of 50 human subjects
conducted for 3 years to earn
provisional acceptance or 5 years to
earn acceptance
68. Turned Surface Implants Have Been
Shown to Have Great Long Term
Success When Used for the
Rehabilitation of Edentulous Patients
Albrektsson & Sennerby 1991, Eckert Et Al. 1997,
Roos Et Al. 1997, Arvidsson Et Al 1998
Findings from experimental studies
Documented that a firmer
Osseointegration was established
With a roughened surface
Carlsson et al 1988, Feighan et al 1995,
Gotfredsen et al 2000, Ivanoff et al 2001
69. Modified implants provide:
•Better mechanical stability
•Proper retention of clot
•Stimulate the healing process
•Less resistance to infection
75. Measuring and Evaluating
Procedure
• Roughness is further described in
terms of:
– Amplitude parameters – Vertical height
of the irregularities
– Spacing parameters – Spacing between
the irregularities
– Hybrid parameters – Information
regarding both amplitude and spacing
parameters
76.
77.
78.
79. Studies Investigating Surface
Roughness and Osseointegration
• Wennerberg and co-workers 1995 a, b;
1996 a,b,c; 1997; 1998
• Ivanoff et al 2001
• Hallgren Hostner 2001
Most ideal osseointegration:
– Amplitude parameter (Sa) – 1.45 μm
– Spacing parameter (Scx) – 11 μm
– Hybrid parameter (Sdr) – 1.5 μm
81. Status of Host Bed
• No pathologic lesion in the bone and
soft tissue should be present
• Well vascularised bone
• Irradiated bone ------ Impaired
healing
82. Protocol for Implant Placement
in Irradiated Bone
1. Delay implant surgery until 6 months after
irradiation.
2. Cessation of smoking.
3.20 preoperative treatment of 100% oxygen
at 2.4 atmospheres for 90 min. Additional
10 treatment after surgery, for a total of
30 peri-operative treatments
83. Protocol for Implant Placement
in Irradiated Bone
5. Increase integration time by 3
months
6. Over-engineered prosthesis
7. Strict oral hygiene regimen
87. Keratinized Tissue
Surrounding Implants
Block et al 1996; Kirsch & Ackermann 1989
• Keratinized mucosa has better esthetic
and functional results for implant
restorations
• Implants with coated surface show greater
peri-implant bone loss and failures in the
absence of keratinized mucosa
89. Surgical Technique at
Insertion
Implants must be sterile and made of a
biocompatible material.
Implant site preparation should be done
under sterile conditions.
90. Surgical Technique at
Insertion
Implant site preparation should be
completed with an atraumatic surgical
technique that avoids overheating of
the bone during preparation of the
recipient site.
91. Surgical Technique at
Insertion
• Implants should be allowed to heal without
loading of micro-movement (i. e.
undisturbed healing period to allow for
osseointegration) for 2 to 4 months and 4
to 6 months in the mandible and maxilla
respectively
• Implants should be placed with good initial
stability
93. Implant Loading
• Mandible:
3 – 4months
• Maxilla:
5 –6 months
Adel et al 1985; Watzek & Ulm 2001
• Soft bone:
Delay implant placement by a month
Friberg et al 1994
94. Implant Overload and Bone
Resorption
• Excessive occlusal loads
• Load resulting in microdamage
• Resorption remodeling response of
bone
• Loss of bone at implant bone
interface due to remodeling
• Vicious cycle
95. Strategies to Avoid Implant
Overload
• Place implants perpendicular to the
occlusal plane
• Place implants in tooth positions
• When in doubt, always add a third
implant
• Avoid the use of cantilevers in linear
configurations
96. Strategies to Avoid Implant
Overload
• Avoid connecting implants to teeth
• If it is necessary to connect implant
to teeth, use a rigid attachment
system
• Control occlusal factors
97. Strategies to Avoid Implant
Overload
• Restore anterior guidance if possible
• Avoid the use of shorter implants
