osseointegration
TRANSCRIPT
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