Factors affecting Osseointegration

Factors affecting Osseointegration

Osseointegration can be affected by

   Bone present

   Implant placed

Bone factors affecting osseointegration

   Sufficient thickness & quality  of bone

   History of  Diabetes Mellitus

   Habits like smoking & bruxism

Implant properties affecting Osseointegration

   Material

   Dimensions of Implant

   Surface coatings

Surface design

Weiss' theory of fibrosseous integration

Weiss' theory of fibrosseous integration

   There is a fibrosseous ligament formed between the implant & the bone.

   This ligament is equivalent to the periodontal ligament found in the gomphosis.

   He advocated early loading of the implant.

Osseointegration by Branemark

Osseointegration by Branemark

   Implants integrate such that bone is laid very close to the implant without any intervening connective tissue

   Implants should be left out of function during the healing period for osseointegration to occur.

Types of Integration

Types of Integration

Fibro- Osseous Integration

  Proposed by Weiss

    Osseointegration proposed

     By Branemark

HISTORY OF Osseointegration

HISTORY OF Osseointegration

   1952- Branemark coined the term Osseointegration

Branemark,  a Swedish surgeon, while conducting research into the healing patterns of bone tissue, accidentally discovered that when pure titanium comes into direct contact with the living bone tissue, the two literally grow together to form a permanent biological adhesion. He named this phenomenon "osseointegration 

Branemark’s Definition of Osseointegration

Branemark’s Definition of Osseointegration

  Branemark, a pioneer in implantology, has stated that osseointegration is a continuing structural & functional existence possibly in a symbiotic manner, between differentiated, adequately remodeled, biologic tissues & strictly defined & controlled synthetic components, providing lasting, specific clinical function without initiating rejection mechanisms.

Dental Implant - OSTEOINTEGRATION

OSTEOINTEGRATION

What is OSSEO INTEGRATION

Originally it was defined as a direct structural & Functional connection between ordered living Bone & the surface of a load bearing implant.

It is now said that an implant is regarded as

osseointegrated when there is no progressive

relative movement between the implant & the

bone with which it has direct contact.

Dental Implant - Final Verdict

Implants have to  :

• Provide mechanical support to the specific organ.

• Induce healing and bone formation.

• Be easily removed if needed.

• Have appropriate reactions with surrounding living tissues 

(biocompatibility).

• Resist the acting loads and probable overloads.

• Resist the long-term actions like fatigue, corrosion, ageing,..

• Be easily sterilized.

Dental Implant - Imaging

IMAGING  IN  DENTAL  IMPLANTOLOGY:

Ú    INTRAORAL PERIAPICAL RADIOGRAPHS (IOPA)

Ú    ORTHOPANTOMOGRAM (OPG)

Ú    COMPUTERISED TOMOGRAM (CT) / DENTASCAN

Ú    3D RECONSTRUCTION & StereoLithoGraphic Models

Ú Until recently, dentists have evaluated the jaw predominantly by using radiographs in their office. The development of dental computed tomographic (CT) reformatting programs, however, has completely revolutionized and changed the fashion in which we radiographically evaluate the jaw today.

Ú Dentists and oral surgeons were experiencing difficulty with the use of conventional radiographs to determine whether there was sufficient bone in the jaw to accommodate these implants. They also found it difficult to determine the exact location of the mandibular nerve and other important structures. As a result, dentists soon began to work with their colleagues in radiology, and a dental CT reformatting program was developed to resolve these issues.

Ú Today, these programs are used to evaluate patients with dental implants; in addition, they are being used to assess tumors, cysts , inflammatory disease, oroantral fistulas, silicone implants , fractures, and surgical procedures.

Ú The programs are useful because they provide accurate information about the height and width of the jaw, as well as information about the location of vital structures, such as the mandibular canal, mental foramen, mandibular foramen, incisive foramen, and maxillary sinuses.

Ú In addition, detailed information about internal anatomy and the relationship between lesions and the cortical margins and roots of the teeth can be established.

These programs are optimally used as an adjunct to, rather than a substitute for, conventional dental radiography. 

Dental Implant - IDEAL REQUISITES & PATIENT EVALUATION

IDEAL  REQUISITES

    

 To achieve an osseointegrated dental implant with a high degree of predictability the implant must be-

Ú Sterile

Ú made of a highly biocompatible material

Ú Inserted with an atraumatic surgical  technique that avoids overheating of the bone.

Ú Placed with initial stability

Ú Not functionally loaded during the healing period

PATIENT  EVALUATION  :

Pre surgical investigations  :

0

Ø    Patient’s history & Clinical Evaluation

Ø    Material biocompatibility

Ø    Implant dimensions

Ø    Implant surface & design

Ø    Host site – Soft tissue & Bone parameters

Ø    Dental Casts

Ø    Imaging

Dental Implant - Parts of Implant

 PARTS  OF  IMPLANT  :

 1. Implant body for Fixture

                It is the component that is placed with in the bone during first stage of surgery.

 2. Healing screw

                During the healing phase this screw is normally placed in the superior surface of body.

     Function: Prevents the growth of the tissue over the edge of  the implant.

 3. Healing caps:

                   Are dome shaped trans-epithelial attachments placed over the sealing screw after the second stage of surgery & before insertion of prosthesis.

              Also called Permucosal extension or Gingival former.

 4.Abutments

                  part of implant which resembles a prepared tooth & supports &/or retains the prosthesis or implant Superstructure.

          Three types – 1. for screw retention

                                    2. for cement retention

                                    3. for attachment

          Each of the three are further classified as  Straight or Angled abutments.

 5. Hygiene cover screw

                Placed over abt for screw retn. to prevent debris & calculus from invading the internally threaded portion of abutment during prosthesis fabrication.

 6. Impression posts ( Transfer coping )

                To position an analogue in an impression.

                Two types -  1. Implant body transfer coping

                                    2.  Abutment transfer coping

                Two basic restorative techniques used & each uses a different design transfer coping – Indirect & direct.

 7. Implant analogue

                Implant body analogue & Implant abutment analogue.

 8. Prosthetic coping

                 To fit the implant abutment for screw retention & serve as a connection between the abutment & prosthesis as superstructure

 9. Coping ( Prosthesis ) screw

Parts of Implants

Dental Implant - Disadvantages

Ú DISADVANTAGES  :

Ú Can not be used in medically compromised patients who cannot undergo surgery.

Ú Longer duration of treatment.

Ú Need of a lot of patients cooperation

Ú Very much expensive.

Dental Implant - Advantages

Ú ADVANTAGES  :

Ú Preservation of bone

Ú Improved function

Ú Aesthetics

Ú Stability and support.

Ú Comfort.

Ú Reliable

Ú Improved Appearance

Ú Improved Comfort

Ú Improved Speech

Ú Chew Your Food Better

Ú Confidence & Convenience

Ú Tooth-saving   Dental implants don't sacrifice the quality of your adjacent teeth like a bridge does because neighboring teeth are not altered to support the implant. More of your own teeth are left untouched, a significant long-term benefit to your oral health!

Ú You feel confident that your replacement teeth won’t move or loosen.

Ú You regain the closest thing to the look, feel and function of your natural teeth.

Ú Forget about unsightly partial denture clasps which place damaging pressure on remaining natural teeth.

Ú Eliminate irritated and painful gums.

Ú Dental implants help stop the progressive bone loss and shrinkage of your jawbone by "mimicking" the roots of natural teeth.

Improved dental hygiene   Dental implants just need regular brushing, flossing and dental hygiene appointments just like your natural teeth.