Biologic Basis Oseointegrated Implants

4. *
Bone
* *
Chamber *
*Courtesy P.I. Branemark

5. *
He immediately recognized the importance
of this phenomenon and during the next
several years he experimented with various
sizes and shapes including a design with
features of both subperiosteal and endoseal
implants. Over 50 designs were tested. He
* and his colleagues finally settled on a simple
screw shape with a hex on the top.
* *Courtesy P.I. Branemark

7. Bone
Implant
*
strut *Courtesy R. James

8.  ubperiosteal implants
S
evolved to take advantage of
this phenomenon
 he design was improved by
T
the addition of implant struts
parallel to the occlusal plane.
 hese designs provided
T
more support for the occlusal
forces and prevented the
implant from being impacted
into the bone.

9. The epithelial migration led to formation of extended
peri-implant pockets which in turn developed chronic
infections. These infections led to the exposure of
the implant struts and eventually loss of the implant.

15. Cytokines and growth factors

18. Implant
Surface

20. Osteoid
Osteoclasts
Mineral
TGF-β, OP-1
Source:
 ecessary
N to maintain bone anchorage during
functional loading during the life of the implant

21. *
Titanium layer
Titanium dioxide
layer *
Surface film of complex phosphates of
titanium and calcium
Noncollagenous bone matrix proteins
(osteopontin, osteocalcin and bone
sialoprotein, ie cement line)
Mineralized bone matrix
*Courtesy of M. Weinlander

22. Sulcus
*
Circumferential
collagen fibers
Bone

23. Sulcus
3 - 4 mm
Circumferential
collagen fibers
Bone

26. 100
80
60
40
20
0

28. Congruent implant sites

29.  n this patient the coronal portion of the
I
bone site was either overheated over- prepared
 he apical portion of the implant is
T
osseointegrated but the upper half of
the implant is encapsulated in fibrous
connective tissue.
 pithelial migration will likely lead to formation of
E
deep peri-implant pockets, chronic
infections and loss of the implant.

30. Wall of osteotomy
With the new surfaces
the gaps between the
implant surface and the
osteotomy site can be up
to two mm and still fill in
with bone if primary
immobilization of the
implant is achieved and
maintained.

32. Immediately following placement the
bone implant appositional index is
approximately 10-15% even in
favorable bone sites such as the
anterior mandible. If the implant is
subjected to occlusal load at this point
and mobilized, a fibrous connective
tissue encapsulation results.

33. " Overpreparation of the site – gap between the bone
and the surface of the implant is too large
• Machined surfaces vs micro-rough surfaces
" Overheating the site – the necrotic bone produced
must be phagocytized before healing and
deposition of new bone can occur
" Micromotion of the implant during the healing phase
• Immediate loading?
" Contamination of the implant surface prior to
placement