GOOD MORNING
INDIAN DENTAL ACADEMY
Leader in continuing dental education www.indiandentalacademy.com
www.indiandentalacademy.com
Endosseous osseointegrated dental implantwww.indiandentalacademy.com
www.indiandentalacademy.com
“OSSEOINTEGRATION”
Guided by : Dr. Suresh Sajjan M.C www.indiandentalacademy.com
Contents :
Historical review
Development of concept of osseointegration
Definitions
Scope of osseointegration
Fibrointegration Vs Osseointegration
Ultra structure of osseointegration
Biology of Osseointegration
Mechanism of osseointegration
• Contact osteogenesis vs distant osteogenesis
• Osteoinduction vs osteoconduction www.indiandentalacademy.com
Anchorage mechanism or Bonding mechanism
• Biomechanical bonding
• Biochemical bonding
Key factors responsible for successful osseointegration
Success criteria of implants
Clinical evaluation of osseointegration
• Invasive methods
• Non invasive methods
Failure and loss of osseointegration
Conclusion
List of references www.indiandentalacademy.com
HISTORICAL REVIEW
www.indiandentalacademy.com
500 BC – Etruscan population
600 AD – Mayan population
“First evidence of use of implants”
1700 – John hunter “Transplantation”
Transmission of various diseases
www.indiandentalacademy.com
1809 Maggiolo
Gold roots
1939 – Strock
Vitallium screw
1948 – Goldberg and Gershkoff1943 – Dahl
Subperiosteal implantwww.indiandentalacademy.com
Consistent failures :
Inflammatory reaction
Gradual bone loss
Fibrous encapsulation
1960 – Linkow Blade vent implant
www.indiandentalacademy.com
“CONCEPT OF OSSEOINTEGRATION”
Dr. Per-Ingvar Branemark Orthopaedic surgeon
Professor University of Goteburg, Sweden.
Threaded implant design made up of pure titanium.www.indiandentalacademy.com
Integrated titanium fixture
1952 vital microscopic studies (Bone marrow of rabbit fibula)
“Osseointegration”
Repair of major mandibular and tibial defects.
Optical chamber
Clinical Study www.indiandentalacademy.com
Development of procedures for rehabilitation of edentulism :
Experimental study in dogs
First experimental study
Subperiosteal and Transosseous
Soft tissue reaction
Use of titanium fixtures
www.indiandentalacademy.com
Two stage procedure
Evidence for osseointegration
Macroscopic level
Histological level
Radiological level
www.indiandentalacademy.com
Intact bone to implant surface
Basic research 1952 to 1965 13-15 year extensive research
1965 First clinical evidence of implant insertion
“Edentulous human patient for resorbed edentulous ridge”
www.indiandentalacademy.com
Definitions :
“The apparent direct attachment or connection of osseous tissue to an inert, alloplastic material without intervening connective tissue”.
- GPT 8
Structurally oriented definition :
“Direct structural and functional connection between the ordered, living bone and the surface of a load carrying implants”.
- Branemarks and associates (1977)
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.
- Albrektson and Johnson (2001)www.indiandentalacademy.com
Clinically :
• Ankylosis of the implant bone interface.
Schroeder and colleagues 1976
“functional ankylosis”
• “It is a process where by clinically asymptomatic rigid fixation of alloplastic material is achieved and maintained in bone during functional loading”
- Zarb and T Albrektson 1991
Biomechanically oriented definition :
“Attachment resistant to shear as well as tensile forces”
- Steinmann et al (1986). www.indiandentalacademy.com
Scope of osseointegration in dentistry
1) Prosthetic rehabilitation of missing teeth
Complete edentulous maxilla and mandible rehabilitation.
Single tooth replacement Partial dental loss replacement
Removable prosthesis Fixed prosthesis
www.indiandentalacademy.com
2) Anchorage for the maxillofacial prosthesis
Auricular Prosthesis
Ocular Prosthesis www.indiandentalacademy.com
3) For rehabilitation of congenital and developmental defects
- Cleft palate
- Ectodermal dysplasia
Nasal prosthesis
www.indiandentalacademy.com
4) Complex maxillofacial defect rehabilitation
6) Orthodontic anchorage.
5) Distraction osteogenesis new bone formation
www.indiandentalacademy.com
AAID (1986) – “Defined fibrous integration as tissue to implant contact with interposition of healthy dense collagenous tissue between the implant and bone”.
“Direct bone to implant interface without any intervening layer of fibrous tissue”.
FIBROINTEGRATION
Vs
Concept of Bony Anchorage
Branemark (1969)
Concept of soft tissue anchorage
Linkow (1970), James (1975), Weiss (1986).
OSSEOINTEGRATION
www.indiandentalacademy.com
Fibrosseousintegration :
“Pseudoligament”, “Periimplant ligament”, “Periimplant membrane”.
Hypothesis – Collagen fibers function similar to the sharpeys fibers in the natural dentition.
Fact : The histological difference between the sharpeys fibers and collagen fibers around the implant.
Natural teeth Implant
Oblique and horizontal group of fibers
Parallel, irregular, complete encapsulation
Uniform distribution of load (Shock absorber)
Difficult to transmit the load
Failure : Inability to carry adequate loads Infection www.indiandentalacademy.com
Parallel fiber arrangement
Complete fiber encapsulation
www.indiandentalacademy.com
Fibrosseousintegration Osseointegration
www.indiandentalacademy.com
ULTRASTRUCTURE OF OSSEOINTEGRATION
Soft tissue interface
Cortical bone
Spongy bone
www.indiandentalacademy.com
Biology of Osseointegration (Branemark)
www.indiandentalacademy.com
Mechanism of osseointegration
Phase Timing Specific occurrence 1. Inflammatory
phase Day 1-10 Adsorption of plasma proteins
Platelet aggregation and activation Clotting cascade activation Cytokine release Nonspecific cellular inflammatory response Specific cellular inflmmatory response Macrophage mediated inflammation.
2. Proliferative phase
Day 3-42 Neovascularization Differentiation, Proliferation and activation of cells. Production of immature connective tissue matrix.
3. Maturation phase
After day 28
Remodeling of the immature bone matrix with coupled resorption and deposition of bone. Bone remodeling in response to implant loading Physiological bone recession. www.indiandentalacademy.com
Contact osteogenesis vs distant osteogenesis :
Osborn and Newesley (1980) : Proposed 2 different phenomena
Distant osteogenesis
Contact osteogenesis
www.indiandentalacademy.com
Contact OsteogenesisRelies on Migration of
Differentiating Osteogenic cell to Implant surface
Undifferentiated Perivascular connective cells
Differentiating Osteogenic cells
Osteoconduction :
Migration of differentiating osteogenic cells from the recipient host bed to implant surface where they attach and proliferate.
Fibrin
Smooth surface Rough surfacewww.indiandentalacademy.com
Osteoinduction :
Phenotypic conversion of undifferentiated mesenchymal cell osteoprogenitor cell Bone forming cell (Osteoblast & osteocyte)
Albrektsson and Johanson (2001) : The term osteoconduction and osteoinduction are inter related but not the identical phenomena that occurs during wound healing.
www.indiandentalacademy.com
Key factors responsible for successful osseointegration
Implant material
biocompatibility
Loading
conditions
Implant design
characteristic
Implant surface characteristic
State of the implantation or host bed
Surgical considerations
www.indiandentalacademy.com
IMPLANT MATERIAL
BIOCOMPATIBILITY
www.indiandentalacademy.com
Implant materials
Metals Ceramics Polymers
Chemical composition
Biological compatibility
Bio inert Bio tolerant Bio active
www.indiandentalacademy.com
Biological biocompatibility
Chemical composition Metals Ceramics Polymers
Biotolerant Gold Polyethylene
Cobalt-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 Bioactive Hydroxyapatite Hydroxyapatite
Tricalcium Tricalcium phosphate phosphate
Calcium Calcium pyrophosphate pyrophosphate
Fluorapatite Fluorapatite
Carbon:vitreous, Carbon:vitreous, pyrolytic pyrolytic
BioglassBioglass
www.indiandentalacademy.com
Metals :
Commercially pure titanium (CPTi) : 99.75%
Most biocompatible material excellent long term clinical function
Adherent, self repairable titanium dioxide (TiO2/ TiO) passivated layer.
(10A0 within seconds, 100A0 within a minute.)
Steinman (1988) referred this layer as Biologically inert
On Histological investigation intimate contact between the titanium surface and the periimplant bone.
(Branemark 1977, Albrektsson et al 1984)
Chemical purity, surface cleanliness Osseointegration www.indiandentalacademy.com
Titanium alloys : Ti6Al4V(90%Ti, 6% Al, 4% V)
Johonson (1992) - Cp titanium higher torque removal values than Ti6Al4V screw 23 vs 16N/cm.
- Higher bony contacts 59 vs 50% after 3 months implant insertion
Experimental investigation at 3, 6 and 12th month
Significantly stronger bone reaction to Cp
Retarded bone formation around the Ti6Al4V leaked out Al ion competing with calcium during early stage of calcification causing osteomalacia
Tantalum and Niobium : High degree of osseointegration
There was evidence of exaggerated macrophage reaction compared to Cp titanium.
www.indiandentalacademy.com
CERAMICS
(Calciumphosphate hydroxyapatite, Al2O3, Tricalcium phosphate)
• Makeup the entire implant
• Applied in the form of coating
Hydroxyapatite coated implant
• Gottlander 1994 – short term and longterm reaction
Short term reaction – Positive, enhanced interfacial bone formation
Long term reaction – Cp titanium 50-70% more interfacial bone compared to HA coated.
• Hahn J (1997) HA coated implant – 97.8%(6 yrs) clinical success.
Matter of concern.Matter of concern.
HA coating loosening – macrophage activation and bone resorption
• Beisbrock + Edgertson – Microbial adhesion, Osseousbreakdown, coating failure.
www.indiandentalacademy.com
POLYMERS
Not used
•Inferior mechanical properties
•Lack of adhesion to living tissues
•Adverse immunological reaction
Limited to
•Shock absorbing components – supra structure component
www.indiandentalacademy.com
IMPLANT
DESIGN CHARACTERISTIC
www.indiandentalacademy.com
Implant Design characteristic :
Implant design refers to the three dimensional structure of the implant.
Form, shape, configuration, geometry, surface macro structure, macro irregularities.
Cylindrical Screw shaped implants.
Threaded Non threaded.
www.indiandentalacademy.com
“Precision fit in the vital bone” Osseointegration
Cylindrical implants / press fit implants :
Severe bone resorption
Lack of bone steady state – micro movements
Alberktsson 1993 – continuing bone saucerization of 1mm -first
year, 0.5mm anually and thereafter increasing rate of resorption
upto 5 year followup.
www.indiandentalacademy.com
Threaded implants :
Documentation for long term clinical function.
Alteration in the design, size and pitch of the threads can influence the long term osseointegration.
Advantages of threaded implants
More functional area for stress load distribution than the cylindrical implants.
Threads improves the primary implant stability avoids micromovement of the implants till osseointegration is achieved.
www.indiandentalacademy.com
Non threaded
•Tendency for slippage
•Bonding is required
•No slippage tendency
•No bonding is required
Threaded
www.indiandentalacademy.com
IMPLANT SURFACE CHARACTERISTIC
www.indiandentalacademy.com
Implant surface characteristics
Topographic propertiesImplant surface texture
& roughness
Physical properties
Surface energy and charge
Physiochemical properties Implant surface chemistry
www.indiandentalacademy.com
Orientation of irregularities on the surface
Degree of roughness of the surface
Orientation of irregularities may give :
-Isotopic surface and anisotropic surface
Wennerberg (1996) Ivanoff (2001) : Better bone fixation (osseointegration) will be achieved with implants with an enlarged isotropic surface as compared to implant with turned anisotropic surface structure.
Surface topography
www.indiandentalacademy.com
1) Turned surface/ machined surface
2) Acid etch surface - HCl and H2SO4
3) Blasted surface – TiO2 / Al2O3 particles
4) Blasted + Acidetch surface (SLA surface)
- Al2O3 particles & HCl and H2SO4
- Tricalcium phosphate & HF & NO3
Different machining process results in different surface topographies
www.indiandentalacademy.com
5) Hydroxyapatite coated surface (HA)
6) Titanium plasma sprayed surface (TPS)
7) Oxidized surface
8) Doped surface
9) Nanosized hydroxyapatite coated surfaces www.indiandentalacademy.com
Additive surface treatment :
Titanium plasma spraying (TPS) hydroxyapatite (HA) coating
Substractive surface treatment :
Blasting with titanium oxide / aluminum oxide and acid etching
Modified surface treatment :
Oxidized surface treatment
Laser treatment
Ion implantation www.indiandentalacademy.com
Machined / turned surfaces : gold standard.
Moderately rough implant surfaces
• Roughness parameter (Sa)
0.04 –0.4 m - smooth
0.5 – 1.0 m – minimally rough
1.0 –2.0 m – moderately rough
> 2.0 m – rough
• Wennerberg (1996) – moderately rough implants developed the best bone fixation as described by peak removal torque and bone to implant contact.
• In vivo studies
Smooth surface < 0.2 m will – soft tissue no bone cell adhesion clinical failure.
Moderately rough surface more bone in contact with implant better osseointegration.
: For faster & firmer bone integration
www.indiandentalacademy.com
Carlsson et al 1988, Gotfredsen (2000) – positive correlation between increasing surface roughness and degree of implant incorporation (osseointegration).
Advantages of moderately rough surface :
Faster osseointegration, retention of the fibrin clot, osteoconductive scaffold, osteoprogenator cell migration.
Increase rate and extent of bone accumulation contact osteogenesis
Increased surface area renders greater osteoblastic proliferation, differentiation of surface adherent cells.
Increased cell attachment growth and differentiation.
Increased rough surfaces :
Increased risk of periimplantitis
Increased risk of ionic leakage / corrosion www.indiandentalacademy.com
Machined / turned surface
SEM x 1000 SEM x 4700
Cp Titanium
Surface roughness profile 5 m
www.indiandentalacademy.com
Titanium plasma sprayed coating (TPS)
The first rough titanium surface introduced
Coated with titanium powder particles in the form of titanium hydride Plasma flame spraying technique
6-10 times increase surface area. Steinemann 1988, Tetsch 1991
Roughness Depth profile of about 15m
www.indiandentalacademy.com
Hydroxyapatite coatings
HA coated implant bioactive surface structure – more rapid osseous healing comparison with smooth surface implant.
Increased initial stability
Can be Indicated - Greater bone to implant
contact area - Type IV bone - Fresh extraction sites - Newly grafted sites
SEM 100X
www.indiandentalacademy.com
Sand blasting Acid etch
The objective
Sand blasting – surface roughness (substractive method)
Acid etching – cleaning
SEM 1000X SEM 7000X
Lima YG et al (2000), Orsini Z et al (2000).
- Acid etching with NaOH, Aq. Nitric acid, hydrofluoric acid.
Decrease in contact angle by 100 – better cell attachment.
Acid etching with 1% HF and 30% NO3 after sand blasting – increase in osseointegration by removal of aluminium particles (cleaning).
Wennerberg et al 1996. superior bone fixation and bone adaptation
www.indiandentalacademy.com
Laser induced surface roughening
Eximer laser – “Used to create roughness”
Regularly oriented surface roughness configuration compared to TPS coating and sandblasting
SEM x 300
SEM x 300SEM x 70
www.indiandentalacademy.com
Physical characteristic :
•Physical characteristic refers to the factors such as surface energy and charge.
Hypothesis : A surface with high energy high affinity for adsorption show stronger osseointegration.
Baier RE (1986) – Glow discharge (plasma cleaning) results in high surface energy as well as the implant sterilization, being conductive to tissue integration.
Charge affects the hydrophilic and hydrophobic characteristic of the surface.
A hydrophilic / easily wettable implant surface : Increases a initial phase of wound healing.
Fact : Increase surface energy would disappear immediately after implant placement.
www.indiandentalacademy.com
Implant surface chemistry :
• Chemical alteration increases bioactivity increase implant bone anchorage.
Chemical surfaces :
• Ceramic coated – hydroxyapatite (HA), Calcium phosphate
• Oxidized/anodized surfaces with electrolytes containing phosphorous, sulfur, calcium, magnesium and flouride.
• Alkali + Heat treatment.
• Ionization, implantation of calcium ion, floride ions
• Doped surfaces with the BONE stimulating factors / growth factors.
www.indiandentalacademy.com
Anchorage Mechanism or Bonding Mechanism in Osseointegrated implants :
Biomechanical bonding
In growth of bone into small surface irregularities of implant surface three dimensional stabilization
Seen in :• Machined / turned screw implant • Blasted /Acid etch surface moderately
rough implant surface.
Based on :• Design characteristic Macrostructure
(Threads, vent, slots) • Surface characteristic Microstructure.
(Chemical surface treatmentwww.indiandentalacademy.com
Surface roughness at the micrometer level / nanometer level
Requirement :
Minimum size of
•50-100m cavities or pores complete bone tissue (ground substance + cellular components + Haversion system)
• 1-10m for calcified bone ground substance.
? At nanometer level - no experimental evidence
Some investigators – nanometer size rough surface can carry proper load. www.indiandentalacademy.com
Biochemical bonding Seen with certain bioactive implant surfaces like :
• Calcium phosphate coated implant surfaces
• HA coated implant surfaces
• Oxidized/ anodized surfaces
Bone bonding / Bonding osteogenesis
Biointegration :
•“Strong chemical bond may develop between the host bone and bioactive implant surfaces and such implants are said to be biointegrated”.
www.indiandentalacademy.com
Doped surfaces that contain various types of bone growth factors or other bone-stimulating agents may prove advantageous in compromised bone beds. However, at present clinical documentation of the efficacy of such surfaces is lacking : BMP = Bone morphogenetic protein.
Doped surfaces
www.indiandentalacademy.com
BONE FACTOR
• Bone quality bone with well
formed cortex and densely
trabaculated medullary spaces
• Bone quantity Refers to the
dimension of available bone in
reference to length, width and
depth.
Initial implant stability
www.indiandentalacademy.com
•Factors compromising the bone quality
Infection ,Irradiation &Heavy smoking
Branemark system (5 year documentation)
Mandible – 95% success
Maxilla – 85-90% success
Aden et al (1981) – 10% greater success rate in anterior mandible compared to anterior maxilla.
Schnitman et al (1988) – lower success rate in posterior mandible compared to anterior mandible
- posterior maxilla higher failure rates.
Difference in bone composition
www.indiandentalacademy.com
LIKHOM AND ZARB CLASSIFICATION 1985
Class I : Jaw consist almost exclusively of homogeneous compact bone
Class II : Thick compact bone surrounds
highly trabecular core
Class III : Thin cortical
bone surrounds highly
trabecular core
Class IV : Thin cortical
bone surrounds loose, spongy
core
D1 D2 D3 D4
MISCH CLASSIFICATION 1988
www.indiandentalacademy.com
According to Branemark and Misch
D1 and D2 bone initial stability / better osseointegration
D3 and D4 poor prognosis
D1 bone – least risk
D4 bone - most at risk
Jaffin and Berman (1991) – 44% failure in type IV bone
Selection of implant
D1 and D2 – conventional threaded implants
D3 and D4 – HA coated or Titanium plasma coated implants
Loss of osseointegration
www.indiandentalacademy.com
Osteopromotion :
Procedure to enhance the formation of bone approximating the implant surface :
• Bone regeneration techniques (using PTFE membrane)
• Bone growth factors like PDGF, IGF, PRP, TGF-B1 stimulates osteoprogenitar cells, enhance the bone growth.
• Stefini CM et al (2000) recommend to apply PDGF and IGF on the implant surfaces before placing into cervical bed. This method showed better wound healing and rapid osseointegration.
www.indiandentalacademy.com
Indications :
1) Localised ridge augmentation prior to implant placement
2) Treatment of periimplant bone defect.
Exposed implant surface
PTFE membrane Regeneration of bone
Increased bone to implant contact www.indiandentalacademy.com
Implantation bed / host bed
•Objective Healthy implant host site
•Nature of the host site - vascularity
- cellularity (osteogenic potential)
Two Factors
•Patient Considerations - Age
•History of proposed host bed – Previous irradiation
- Infection
- History of smoking
- Advanced ridge resorption
- Osteoporosis or osteoporotic like bone lesion www.indiandentalacademy.com
Age :
Old age – no poorer result
Extreme young age - Relative contraindication to insertion of implants.
Infrapositioning of implant because of alveolar growth
Wait till the completion of growth
Maxillofacial deformities : implant placement is delayed until the child is at puberty.
Only in selected cases
ex: Ectodermal dysplasia
Anterior part of the jaw + over denture therapy.
Bone anchored hearing aids :
2-3 year old child.www.indiandentalacademy.com
Smoking and osseointegration :
• History of smoking may affects the healing response in osseointegration.
• Lower success rates with oral implants
• Mechanism behind
Vasoconstriction
Reduced bone density
Impaired cellular function
• Mean failure rates in smoker is about twice than in non smoker.
www.indiandentalacademy.com
Radiation therapy and osseointegration :
• Jacobsson (1985) previous irradiation – relative contraindication for implant placement.
• Expected success rate 10-15% lower than the non irrradiated patients.
Number of factors to be considered :
• Dose and fraction of irradiation
• Timing from radiotherapy to implant surgery
• Anatomic region in which the implant to be inserted
• Loading factors and handling of the soft tissue.
Full course radiotherapy (50-65Gy) Not contraindicated.
> 65 Gy critical for implant survival.
• Johnson (1987) Surgical risk 1m before and 6m after,
Low risk 6m to 1.5 yr
Increased risk there after. www.indiandentalacademy.com
Hyperbaric oxygen therapy (HBO) :
• HBO Elevates the partial pressure of oxygen in the tissues.
• Granstrom G (1998) HBO can counteract some of the negative effect from irradiation and act as a stimulator for osseointegration.
• Role of HBO in osseointegration
– Bone cell metabolism
- Bone turnover
- Implant interface and the capillary network in the implant bed
(angiogenesis)
www.indiandentalacademy.com
SURGICAL CONSIDERATIONS
www.indiandentalacademy.com
Objective:
Minimum tissue violence – osseointegration
Controlled surgical technique
Surgical skill / technical excellence
Parameters :
• Profuse irrigation for continuous / Adequate cooling
•Use of well sharpened drills and use of graded series of drills
Violent surgical techniques
www.indiandentalacademy.com
• Slow drill speeds
• Proper drill geometry
• Intermitent drilling
Eriksson R.A :
• Drill speed < 2000 rpm, tapping at 15 rpm.
• Cooling during tapping and insertion of screw
Others
• Cooling the irrigants
• Using internally irrigated drills
Violent surgical technique
• Frictional heat / overheating increased temperature rise in bone wide zone of necrosis fibrous tissue, primary failure of osseointegration. www.indiandentalacademy.com
Erickson RA www.indiandentalacademy.com
Critical temperature for bone necrosis
• Previously 560 to 700 for 1 min.
• 560C critical temperature for bone necrosis Irreversible bone damage.
• Recently 470C for 1 min.
Denaturation of alkaline phosphate enzyme inhibition of Alkaline Ca synthesis Loss osseointegration (Errickson 1986, Albrektsson 1984) www.indiandentalacademy.com
Insertion torque
Insertion torque is high – removal torque is low.
Poor osseointegration
High torque is used stress / compression in bone
Holding power of implant will fall.
45 N/cm
Moderate torque should be used
www.indiandentalacademy.com
IMPLANT
LOADING
www.indiandentalacademy.com
Loading condition
Objective : “No loading while healing” successful osseointegration.
Movement of the implant within the bone – fibrous tissue encapsulation rather than osseointegration.
Premature loading leads to implant
movement
The end result “Soft tissue interface”
“Bony interface”
www.indiandentalacademy.com
Branemark, Albrektson – two stage implant insertion.
First stage – Installation of fixture into bone
Second stage – Connection of abutment to the fixtures
Maxilla 6 months
Mandible 3 months
Misch – Progressive / Gradual loading
Different Philosophies regarding Loading conditions
Suggested in Softer boneless number of implants to be used
www.indiandentalacademy.com
Immediate functional loading protocol
Clinical trials successful osseointegration
(95-100% success rate- Completely edentulous patients)
Bone quality is good
Functional forces are controlled
More favourable in mandible compared to maxilla
Over loading – Stress concentration, undermining bone resorption without apposition (Branemark 1984)
To decrease the bio mechanical loadProsthetic design considerationsCantilever length may be shortened or eliminatedNarrow occlusal tableMinimizing the offset loadIncreasing the implant numberUse of wider implant with D4 bone compared to D1 & D2www.indiandentalacademy.com
Success criteria of implants :
Schuitman and Schulman criteria (1979)
1) The mobility of the implant must be less than 1mm when tested clinically.
2) There must be no evidence of radiolucency
3) Bone loss should be less than 1/3rd of the height of the implant
4) There should be an absence of infection, damage to structure or violation of body cavity, inflammation present must be amneable to treatment.
5) The success rate must be 75% or more after 5 years of functional service.
www.indiandentalacademy.com
Albrektson and Zarb G (1980)
1) The individual unattached implant should be immobile when tested clinically
2) The radiographic evaluation should not show any peri-implant radiolucency
3) Vertical bone loss around the fixtures should be less than 0.2mm annually after first year of implant loading.
4) The implant should not show any sign and symptom of pain, infection, neuropathies, parastehsia, violation of mandibular canal and sinus drainage.
5) Success rate of 85% at the end of 5 year observation period and 80% at the end of 10 year service.
Smith and Zarb (1989)
6) Implant design allow the restoration satisfactory to patient and dentist. www.indiandentalacademy.com
METHODS OF EVALUATION OF OSSEOINTEGRATION
Invasive method
•Histological section
•By using torque gauges
•TEM (transmission electron microscopy)
•Pullout test
•Histomorphometric
www.indiandentalacademy.com
Non-invasive methods :
•Radiographs
•Periotest
•Reverse torque
www.indiandentalacademy.com
•Resonance frequency analysis
•Dynamic model testing
•Impulse testing
www.indiandentalacademy.com
www.indiandentalacademy.com
List of References :
Osseointegration in clinical dentistry – Branemark, Zarb, Albrektsson
Osseointegration and occlusal rehabilitation – Sumiya Hobo
Contemporary Implant Dentistry – Carl. Misch
Endosseous implants for Maxillofacial reconstruction – Block and Kent
Implants in Dentistry –Block and Kent
Dental and Maxillofacial Implantology – John. A. Hobkrik, Roger Watson
Endosseous Implant : Scientific and Clinical Aspects – George Watzak
Optimal Implant Positioning and Soft Tissue management – Patrik Pallaci
Osseointegration in craniofacial reconstruction. T. Albrektssson.
Osseointegration in dentistry : an introduction : Philip Worthington, Brein. R. Lang, W.E. Lavelle.
IJOMI 2005; 20(2): 307-311
IJOMI 2005; 20: 425-31
IJP 2004; 17: 536-543. www.indiandentalacademy.com
IJOMI 2000; 15(1): 76-94.
IJOMI 2000; 15: 675-690.
IJOMI 1988 ; 3 : 231-246
IJP, 1998 ; 5 : 491-500.
JPD, 1983, 50 : 399-410.
D.C.N.A., 1986 ; 10-34, 151-160
D.C.N.A., 1992 ; 36, 1-17
JPD, 1983 ; 50 : 108-113.
JPD, 1983; 50:832-37.
IJP, 1990 ; 3 : 30-41.
IJP, 1998 ; 11 :391-401.
J. Perio. Rest 1981 ; 16 : 611-616.
JPD 1993 ; 69 : 281-288.
Int J. Periodont Rest Dent 1995 ; 15 : 345-361.
Int J Oral Maxillofac Surg. 1986 ; 144 : 274-282.
Int J Periodont Restorative Dent 1998 ; 18 : 553-563.
J Periodontal 1997 ; 68 : 591-597.
www.indiandentalacademy.com
Thank you
For more details please visit
www.indiandentalacademy.com
www.indiandentalacademy.com