osseointegration

Dr. Kritika JangidMDS (Periodontics and Implantology)

OSSEOINTEGRATION

Dr. Kritika Jangid

Dr. Kritika Jangid

A look at history 4000 years ago- China, carved bamboo

pegs were used to replace missing teeth.

3000 years- Egyptian king had a copper peg hammered into his upper jaw bone.

Dr. Kritika Jangid

2300-year-old iron false tooth was recently found among real teeth in a Celtic grave in France.

Dr. Kritika Jangid

Maya Civilization- 600 AD

Dr. Kritika Jangid

Dr and Mrs Wilson Popenoe, in 1931 Jaw with three carved, tooth-shaped

shells in the lower jaw of a human’s remains.

Bone structure around the shell showed signs of regeneration.

Maya Civilization- 600 AD

Dr. Kritika Jangid

Dr. Kritika Jangid

Bothe et al. (1940) were the first researchers to implant titanium in an animal and remarked how it had the tendency to fuse with bone.

Dr. Kritika Jangid

Osseointegration was later described by Gottlieb Leventhal in 1951

Titanium screws in rat femurs At the end of 6 weeks, the screws were

slightly tighter than when originally put in; At 12 weeks, the screws were more

difficult to remove At the end of 16 weeks, the screws were

so tight that in one specimen the femur was fractured when an attempt was made to remove the screw.

Dr. Kritika Jangid

Per-Ingvar Brånemark Father of Modern Implantology Coined the term ‘Osseointegration’

Dr. Kritika Jangid

In 1952 Vital microscopy studies in rabbits using

titanium optic chambers.

Dr. Kritika Jangid

Brånemark’s experiment on Dogs

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Brånemark (right) with his first patient Gösta Larsson.

Dr. Kritika Jangid

OSSEOINTEGRATION Albrektsson (1981)- A direct functional and

structural connection between living bone and the surface of a load carrying implant.

Zarb and Albrektsson (1991)- A process whereby clinically asymptomatic rigid fixation of alloplastic materials is achieved and maintained in the bone during functional loading.

Dr. Kritika Jangid

American Academy of Implant Dentistry

“contact established without interposition of non bone tissue between normal remodelled bone and on implant entailing a sustained transfer and distribution of load from the implant to and within bone tissue.”

Dr. Kritika Jangid

TERMINOLOGIESOSSEOINTEGRATION

FUNCTIONAL ANKYLOSISFIBRO-OSSEOUS

INTEGRATIONBIO-INTEGRATION

Dr. Kritika Jangid

By- Branemark

OSSEOINTEGRATION

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Linkow in 1970 James in 1975 Charles Weiss in 1986

FIBRO-OSSEOUS INTEGRATION

American Academy of implant dentistry defined fibrous integration as tissue to implant contact with healthy dense collagenous tissue between the implant and bone.

The fibers are arranged irregularly, parallel to the implant body, when forces are applied they are not transmitted through the fibers. So no bone remodeling expected in fibro- integration.

Dr. Kritika Jangid

Meffert divided osseointegration

Adaptive osseointegrationBiointegration

Dr. Kritika Jangid

BIOINTEGRATION Characteristic of an implant material that

allows attachment to living tissues, whereas a non bioactive material would form a loosely adherent layer of fibrous tissue at the implant interface

Bioactive retention is achieved with bioactive materials such as hydroxyapatite (HA), which bond directly to bone

Dr. Kritika Jangid

OSSEOINTEGRATION

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Small biomolecules,Water, IonsLarge molecules,Tissue fragments

UDM Cells of Bone marrow/ Blood cells

Dr. Kritika Jangid

After 2 hrs

Dr. Kritika Jangid

After 4 days

•Granulation tissue• Mesenchymal cells• Matrix components• Newly formed vascular structures

(Provisional Connective tissue)

Dr. Kritika Jangid

1 week

Newly formed

osteoblasts

Vascular Supply & Oxygen Tension

UDM Pre-osteoblast

Dr. Kritika Jangid

2 weeks

Dr. Kritika Jangid

4 weeks

Dr. Kritika Jangid

6- 12 weeks

Dr. Kritika Jangid

Contact v/s Distance osteogenesis Davies 1998

Dr. Kritika Jangid

Implant related factors

Patient related factors

Surgical

factors

FACTORS THAT INFLUENCEOSSEOINTEGRATION

Dr. Kritika Jangid

IMPLANT RELATED FACTORS

Implant Biomaterial Implant Surface Topography Implant Surface Modifications

Dr. Kritika Jangid

Biological biocompatibility

Chemical composition Metals Ceramics Polymers

Biotolerant Gold PolyethyleneCobalt-chromium alloys

Polyamide

Stainless steel Polymethylmethacrylate Zirconium Polytetrafluoroethylene Niobium Polyurethane Tantalum

Bioinert Commercially pure titanium

Aluminum oxide

Titanium alloy (Ti-6Al-4V)

Zirconium oxide

Bioactive Hydroxyapatite Tricalcium phosphate

Calcium pyrophosphate

Fluorapatite Carbon:vitreous, pyrolytic

Bioglass

Dr. Kritika Jangid

Dr. Kritika Jangid

Why titanium? 99.75 percent commercially pure titanium

is the most biologically inert material

Titanium alloys with vanadium, cobalt and

niobium also has good biocompatibility

and inertness

Forms a good intimate bond with the bone

Dr. Kritika Jangid

INFUENCE OF IMPLANT DESIGN ON OSSEOINTEGRATION

IMPLANTS ARE BROADLY CLASSIFIED ASCYLINDRICAL

SCREW SHAPED

THREADED

NON THREADED

Dr. Kritika Jangid

Cylindrical Implants

Associated with more resorption

More micro-movements can occur

Dr. Kritika Jangid

Screw Shaped Implants

Better due to taper

Lesser resorption and micromovements

Dr. Kritika Jangid

Threaded ImplantsMore surface area for

bone contact

Better for long term

osseointegration

No slippage will occur

Less micro-

movements

Dr. Kritika Jangid

Non- Threaded ImplantsInferior compared to

threaded implants as

far as long term

osseointegration is

concerned

More slippage

Dr. Kritika Jangid

IMPLANT SURFACE RELATED FACTORS THAT AFFECT OSSEOINTEGRATION

SURFACE TEXTURE AND

ROUGHNESS

SURFACE CHEMISTRY

SURFACE ENERGY AND CHARGE

Dr. Kritika Jangid

PROCESSES TO MODIFY SURACE TOPOGRAPHY

Achieves a moderately rough surface and good results, good clot retention, good scaffold for cell migration but increased risk of peri-implantitis

Acid etching- cleaning of the implant with H2SO4, HCl

Blasting – this process increases surface roughness, subtractive method and increases surface area

Blasting plus etching- subtractive method

Coating nanosize HA- increased initial stability, more rapid healing, indicated in fresh sockets and type 4 bone

Plasma spraying – coating the implant with powder in the form of titanium hydride causes a 6 to 10 time increase in surface area

Doping- involves incorporation of growth factors onto the surface to accelerate healing- PDGF, TGFbeta

Laser- excimer laser can cause increased surface area and result in a better isotropic surface

Dr. Kritika Jangid

HA Coating

Have short term success and good bone

adhesion

On the loosening of the coating that can

occur after 6 to7 years there is a

phenomenon of macrophage activation and

osseous breakdown

Dr. Kritika Jangid

EFFECT OF SURFACE ENERGY ON OSSEOINTEGRATION

Increase in surface energy results in high affinity for surface adsorption and pellicle formation and increased osseointegration

A hydrophilic surface contributes to an increased initial healing phase

Dr. Kritika Jangid

EFFECT OF BONE RELATED FACTORS ON OSSEOINTEGRATION

QUALITY

QUANTITY

BETTER OSSEOINTEGRATION

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Lekholm and Zarb (1985)

Dr. Kritika Jangid

Dr. Kritika Jangid

Misch (1988)

Dr. Kritika Jangid

PATIENT RELATED FACTORS THAT AFFECT OSSEOINTEGRATION

Age Systemic factors Irradiation therapy-Jacobson et al have

documented a 10 to 15 percent decrease in osseointegration

Periodontitis Smoking Osteoporosis

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

SURGICAL FACTORS THAT AFFECT OSSEOINTEGRATION Tissue handling- minimum tissue trauma improves results

Controlled surgical technique is important

Profuse irrigation is a must to prevent bone heating and

necrosis

Use of sharp drills with a drill speed of less than 2000rpm is

desired

56 degrees is the critical temperature to prevent bone

overheating

Use of torque wrench with moderate torque of 45 N/cm is ideal

Dr. Kritika Jangid

METHODS TO ASSESS OSSEOINTEGRATION

HistomorphometryUse of torque gauges

TEMPull out testRadiographs

Cone beam CTPeriotest

Resonance frequency analysis

Dynamic model testingImpulse testing

Dr. Kritika Jangid

FAILURES OF OSSEOINTEGRATION Early- failure to establish a close bond to

implant

Late- disruption of established contact

Biologic – Bacterial

Mechanical(Aseptic) – due to overload and fracture

Dr. Kritika Jangid

Albetkson and Zarb criteria for a ideal osseointegrated implant

1. The individual unattached implant should be immobile

when tested clinically

Dr. Kritika Jangid

2. The radiographic evaluation should not show any peri-

implant radiolucency

Dr. Kritika Jangid

3. Vertical bone loss around the fixtures should be less than

0.2mm annually after first year of implant loading.

Dr. Kritika Jangid

4. The implant should not show any sign and symptom of pain,

infection, neuropathies, parastehsia, violation of

mandibular canal and sinus drainage.

Dr. Kritika Jangid

5. Success rate of 85% at the end of 5 year observation period

and 80% at the end of 10 year service.

Dr. Kritika Jangid

5. Success rate of 85% at the end of 5 year observation period

and 80% at the end of 10 year service.

Dr. Kritika Jangid

IMMEDIATE , EARLY V/S DELAYED

Immediate Loading: Same day to 1 week

Early Loading: 1 week to 2 months

Conventional Loading: 2 months to 6 months (BRANEMARK)

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

FUTURISTIC CONCEPTS

Dr. Kritika Jangid

Threshold for Tactile discrimination

50µ 8µ

Dr. Kritika Jangid

OSSEOPERCEPTION

Dr. Kritika Jangid

BIO-HYBRID IMPLANT

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid

Dr. Kritika Jangid