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OSSEOINTEGRATION
INTRODUCTIO
N
HISTORICAL
REVIEW
DEFINITION
S
MECHANISM OF
OSSEOINTEGRA
TION
BONE TO
IMPLANT
INTERFACE
HISTORY OF
BRANEMARK
SYSTEM
BONE FORMATION
AROUND IMPLANTS
STAGES
BONETISSU
E
RESPONSE
BIOLOGICAL
ATTACHMENT
BIOLOGICAL PROCESS
OF INTEGRATION
MECHANISM OF
INTEGRATION
FACTORS THAT
INFLUENCE
OSSEOINTEGRATI
ON
FAILURESCONCLUSION
FUTURISTIC
CONCEPTS
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.
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 .
 In 1952 ,Vital microscopy studies in rabbits
using titanium optic chambers.
.
EARLY STAGE (1965-1968)
DEVELOPMENTAL STAGE (1968-1971)
PRODUCTION STAGE (1971 – PRESENT)
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
“It is a process where by clinically asymptomatic
rigid fixation of alloplastic material is achieved
and maintained in bone during functional
loading” - Zarb andT Albrektsson (1991)
Histologically, Direct anchorage of an implant by the
formation of bone directly on the surface of an implant
without any intervening layer of fibrous tissue. -
Albrektsson and Johnson (2001)
Clinically Ankylosis of the implant bone
interface.“Functional ankylosis” -Schroeder and
colleagues (1976)
Biomechanically oriented definition
“Attachment resistant to shear as well
as tensile forces” - Steinmann et al
(1986).
 American Academy of Implant Dentistry (AAID)
defined Osseointegration as "contact established
without interposition of non-bone tissue between
normal remodeled bone and an implant entailing a
sustained transfer and distribution of load from the
implant to and within the bone tissue"
TWO BASICTHEORIES :
OSSEOINTEGRATION (BRANEMARK 1985)
FIBRO-OSSEOUS INTEGRATION
(LINKOW 1976 JAMES 1975WEISS 1986)
 Meffert et al (1987)
ADAPTIVE- OSSEOINTEGRATION
BIOINTEGRATION
Osseointegration
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’’
 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”.
 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.
• 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)
The device
 Two consecutive profiles of the pitch.
 U shaped circumferential trough.
 Pitch engages hard tissue walls
 Void between pitch and body of implant – wound chamber.
Berglundh et al (2003) and
Abrahamsson et al (2004).
The wound chamber
 Blood clot
 Erythrocytes, neutrophils and monocytes
 Leukocytes – cleansing process.
Fibroplasia
 4 days of healing
 Coagulum replaced by granulation tissue.
 Mesenchymal cells, matrix components
 Angiogenesis.
 Provisional connective tissue.
Bone modelling
 1 week of healing
 Vascular structures with few inflammatory cells.
 Cell rich immature (WOVEN) bone.
(Centre of chamber and direct contact of implant surface.)
 1st phase of osseointegration.
2 weeks
 woven bone pronounced.
 Woven bone extends from parent bone into connective
tissue.
 Mature osseointegration
 Pitch – ongoing new bone formation
 Recipient site immediate to implant in direct contact –
bone resorption with new bone formation.
4 weeks
 Cell-rich woven bone covered most of titanium.
 Central portion – primary spongiosa – vascular
structures and mesenchymal cells.
Remodelling
 After 6-12 weeks – mineralised bone.
 Primary and secondary osteons
 Bone marrow, adipocytes and mesenchymal cells.
OSTEOPHYLIC STAGE
OSTEOCONDUCTIVE
OSTEOADAPTIVE
 According to Misch,
there are two stages in osseointegration,
 Each stage been again divided into two substages.
STAGE 1: WOVEN CALLUS (0-6 WEEKS)
STAGE 2: LAMELLAR COMPACTION (6-18 WEEKS)
REMODELING, MATURATION
STAGE 3: INTERFACE REMODELING (6-18 WEEKS)
STAGE 4: COMPACT MATURATION (18-54 WEEKS)
 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
 Lamellar compaction
 The woven callus matures as it is replaced by
lamellar bone.
 This stage helps in achieving sufficient
strength for loading.
 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.
 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.
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.
• The direct migration of bone-building cells
through the clot matrix to the implant surface.
• Bone is quickly formed directly on the implant
surface.
(Davies - 1998) Contact osteogenesis :
EARLY PHASES OF
OSTEOGENIC CELL MIGRATION
(OSTEOCONDUCTION)
DE NOVO BONE FORMATION
BONE REMODELING AT
DISCRETE SITES.
PATIENT RELATED
FACTORS
SURGICAL
FACTORS
IMPLANT
RELATED
FACTORS
 Implant Biomaterial(Biocompatibility)
 Implant Biomechanics
 Implant Design
 ImplantTaper
 Apical Design
 Implant Width
 Crest module design
 Implant SurfaceTopography(Surface roughness)
 Implant Surface Modifications
 Contamination
 Heat Production
 Implant Loading
 Cone beam CT Periotest
 Dynamic model testing
 Impulse testing
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.
AlbrektssonT, Zarb G, Worthington P, Eriksson AR.
Osseoperception is defined as mechanoreception in the absence of a functional
periodontal mechanoreceptive input but derived from temporomandibular
joint (TMJ)
•Thorough understanding and application of factors
affecting the osseointegration and biological process of
osseointegration in clinical practice is the key factor for
success.
• The “osseointegration” is a multifactorial entity.
• Achieving the osseointegration of the endosteal
dental implants needs understanding of the many
clinical parameters.
 Hobo, Ichida, Garcia “Osseointegration and occlusal
rehabilitation” Quintessence Publishing.
 Jan Lindhe “Clinical periodontology and implant
dentistry” 4th edition, Blackwell Publishing.
 Elaine McClarence “Branemark and the development of
osseointegration” Quintessence publication
 Carl E. Misch “Implant dentistry” 2nd edition, Mosby.
 Charles M.Weis “Principles and practice of implant
dentistry” Mosby.
 Per Ingvar Branemark “Osseointegration and its
experimental background” JPD 1983Vol. 50, 399-410.
 Hanson, Alberktson “Structural aspects of the interface
between tissue and titanium implants” JPD 1983 vol.
50, 108-113.
 T. Alberktson “Osseointegrated dental implants” DCNAVol.
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.
THANK YOU

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"OSSEOINTEGRATION"

  • 2. INTRODUCTIO N HISTORICAL REVIEW DEFINITION S MECHANISM OF OSSEOINTEGRA TION BONE TO IMPLANT INTERFACE HISTORY OF BRANEMARK SYSTEM BONE FORMATION AROUND IMPLANTS STAGES BONETISSU E RESPONSE BIOLOGICAL ATTACHMENT BIOLOGICAL PROCESS OF INTEGRATION MECHANISM OF INTEGRATION FACTORS THAT INFLUENCE OSSEOINTEGRATI ON FAILURESCONCLUSION FUTURISTIC CONCEPTS
  • 3. 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. 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.  In 1952 ,Vital microscopy studies in rabbits using titanium optic chambers. .
  • 6.
  • 7.
  • 8.
  • 9. EARLY STAGE (1965-1968) DEVELOPMENTAL STAGE (1968-1971) PRODUCTION STAGE (1971 – PRESENT)
  • 10. 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
  • 11. “It is a process where by clinically asymptomatic rigid fixation of alloplastic material is achieved and maintained in bone during functional loading” - Zarb andT Albrektsson (1991) Histologically, Direct anchorage of an implant by the formation of bone directly on the surface of an implant without any intervening layer of fibrous tissue. - Albrektsson and Johnson (2001)
  • 12. Clinically Ankylosis of the implant bone interface.“Functional ankylosis” -Schroeder and colleagues (1976) Biomechanically oriented definition “Attachment resistant to shear as well as tensile forces” - Steinmann et al (1986).
  • 13.  American Academy of Implant Dentistry (AAID) defined Osseointegration as "contact established without interposition of non-bone tissue between normal remodeled bone and an implant entailing a sustained transfer and distribution of load from the implant to and within the bone tissue"
  • 14. TWO BASICTHEORIES : OSSEOINTEGRATION (BRANEMARK 1985) FIBRO-OSSEOUS INTEGRATION (LINKOW 1976 JAMES 1975WEISS 1986)
  • 15.  Meffert et al (1987) ADAPTIVE- OSSEOINTEGRATION BIOINTEGRATION Osseointegration
  • 16. 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’’
  • 17.  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”.
  • 18.  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.
  • 19. • 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)
  • 20. The device  Two consecutive profiles of the pitch.  U shaped circumferential trough.  Pitch engages hard tissue walls  Void between pitch and body of implant – wound chamber. Berglundh et al (2003) and Abrahamsson et al (2004).
  • 21. The wound chamber  Blood clot  Erythrocytes, neutrophils and monocytes  Leukocytes – cleansing process.
  • 22.
  • 23. Fibroplasia  4 days of healing  Coagulum replaced by granulation tissue.  Mesenchymal cells, matrix components  Angiogenesis.  Provisional connective tissue.
  • 24. Bone modelling  1 week of healing  Vascular structures with few inflammatory cells.  Cell rich immature (WOVEN) bone. (Centre of chamber and direct contact of implant surface.)  1st phase of osseointegration.
  • 25. 2 weeks  woven bone pronounced.  Woven bone extends from parent bone into connective tissue.  Mature osseointegration  Pitch – ongoing new bone formation  Recipient site immediate to implant in direct contact – bone resorption with new bone formation. 4 weeks  Cell-rich woven bone covered most of titanium.  Central portion – primary spongiosa – vascular structures and mesenchymal cells.
  • 26.
  • 27. Remodelling  After 6-12 weeks – mineralised bone.  Primary and secondary osteons  Bone marrow, adipocytes and mesenchymal cells.
  • 28.
  • 29.
  • 30.
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  • 33.
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  • 35.
  • 36.
  • 37.  According to Misch, there are two stages in osseointegration,  Each stage been again divided into two substages.
  • 38. STAGE 1: WOVEN CALLUS (0-6 WEEKS) STAGE 2: LAMELLAR COMPACTION (6-18 WEEKS) REMODELING, MATURATION STAGE 3: INTERFACE REMODELING (6-18 WEEKS) STAGE 4: COMPACT MATURATION (18-54 WEEKS)
  • 39.  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
  • 40.  Lamellar compaction  The woven callus matures as it is replaced by lamellar bone.  This stage helps in achieving sufficient strength for loading.
  • 41.  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.
  • 42.  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.
  • 43.
  • 44.
  • 45.
  • 46.
  • 47. 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.
  • 48. • The direct migration of bone-building cells through the clot matrix to the implant surface. • Bone is quickly formed directly on the implant surface.
  • 49. (Davies - 1998) Contact osteogenesis : EARLY PHASES OF OSTEOGENIC CELL MIGRATION (OSTEOCONDUCTION) DE NOVO BONE FORMATION BONE REMODELING AT DISCRETE SITES.
  • 51.  Implant Biomaterial(Biocompatibility)  Implant Biomechanics  Implant Design  ImplantTaper  Apical Design  Implant Width  Crest module design  Implant SurfaceTopography(Surface roughness)  Implant Surface Modifications  Contamination  Heat Production  Implant Loading
  • 52.
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  • 98.
  • 99.
  • 100.  Cone beam CT Periotest  Dynamic model testing  Impulse testing
  • 101.
  • 102. 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. AlbrektssonT, Zarb G, Worthington P, Eriksson AR.
  • 103.
  • 104.
  • 105.
  • 106.
  • 107.
  • 108.
  • 109.
  • 110. Osseoperception is defined as mechanoreception in the absence of a functional periodontal mechanoreceptive input but derived from temporomandibular joint (TMJ)
  • 111.
  • 112.
  • 113.
  • 114. •Thorough understanding and application of factors affecting the osseointegration and biological process of osseointegration in clinical practice is the key factor for success. • The “osseointegration” is a multifactorial entity. • Achieving the osseointegration of the endosteal dental implants needs understanding of the many clinical parameters.
  • 115.  Hobo, Ichida, Garcia “Osseointegration and occlusal rehabilitation” Quintessence Publishing.  Jan Lindhe “Clinical periodontology and implant dentistry” 4th edition, Blackwell Publishing.  Elaine McClarence “Branemark and the development of osseointegration” Quintessence publication  Carl E. Misch “Implant dentistry” 2nd edition, Mosby.
  • 116.  Charles M.Weis “Principles and practice of implant dentistry” Mosby.  Per Ingvar Branemark “Osseointegration and its experimental background” JPD 1983Vol. 50, 399-410.  Hanson, Alberktson “Structural aspects of the interface between tissue and titanium implants” JPD 1983 vol. 50, 108-113.
  • 117.  T. Alberktson “Osseointegrated dental implants” DCNAVol. 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.