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Implants > Osseointegration > Flashcards

Osseointegration Flashcards

1
Q

6 Key Factors For Successful Implant Osseointegration

A
  1. Biocompatibility of the Implant material
  2. Macroscopic and microscopic nature of the implant surface
  3. The status of the implant bed in both a health (non-infected)
    and a morphologic (bone quality) context
  4. The surgical technique
  5. The undisturbed healing phase
  6. The subsequent prosthetic design and long term loading phase
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2
Q

Why do we use titanium and titanium alloys for implants?

A
  • Low weight high strength/weight ratio
  • Low modulus of elasticity,
  • Excellent corrosion resistance
  • Excellent biocompatibility
  • Easy shaping and finishing.
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3
Q

What is the most frequently used titanium alloy and what is its composition?

A

(titanium.6 aluminum-4 vanadium) :
- 90% titanium,
- 6% aluminum (decreases the specific weight and improves the elastic
modulus)
- 4% vanadium (decreases thermal conductivity and increases the
hardness).

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4
Q

TITANIUM OXYDE LAYER:

A

tenacious oxides in air or oxygenated
solutions
- Promotes adhesion of osteogenic cells

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5
Q

What is another option for implant material if patient doesn’t like metal or titanium?

A

zirconia

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6
Q

Surface topography influences…

A

osteoblasts morphology

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7
Q

What surface topography is best for osetoblast morphology: smooth, moderately rough, or rough?

A

the middle option (moderately rough)

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8
Q

Smooth
Minimally Rough
Moderately Rough
Rough

A

Smooth: (Sa<0.5μm)
Minimally Rough: (Sa 0.5-1 μm)
Moderately Rough: (Sa 1-2μm) ** ideal
Rough: (Sa>2 μm)

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9
Q

Smooth and minimally rough surfaces showed
Moderately rough surfaces showed

A

less strong bone responses than rougher surfaces.
stronger bone responses than rough in some studies.

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10
Q

Surface topography influences bone response at the __________ level.

A

micrometre

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11
Q

What does surface modifications involve?

A
  • Changing the surface topography using PHYSICAL AND/OR CHEMICAL methods
  • Transforming surface properties by COATING with a highly biocompatible material
  • Or a COMBINATION of both
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12
Q

What are examples of Surface Modifications?

A
  • Machined
  • Plasma-spray or Titanium spray
  • Sandblasted
  • Sandblasted and acid-etched
  • RBM (Resorbable Blast Media, with Calcium Phosphate)
  • Zirconia ceramic
  • Hydroxyapatite Coatings
  • Lasers
  • Nano-structured surfaces
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13
Q

Which 2 surface modifications do we use at UMKC most often?

A

ACID ETCH
PLASMA SPRAY

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14
Q

A greater surface roughness
increases the potential for…

A

biomechanical interlocking

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15
Q

Rougher implants surfaces have an higher percentage
of…

A

bone implant contact and also an higher torque removal than machined surfaces

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16
Q

What is the bone chemical composition?

A

Inorganic (65-70%)
Organic (30-35%)

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17
Q

What is the inorganic part of bone (65-70%)?

A

Crystalline salts (primarily, hydroxyapatite)

18
Q

What is the organic part of bone (30-35%)?

A
  • Type I collagen (90-95%)
  • Non-collagenous proteins
  • Proteoglycans
  • Growth factors
19
Q

What are the different cells in bone?

A
  • pre-osteoblast
  • osteoblast (creates bone)
  • osteocyte (communication through bone)
  • osteoclast (break down bone)
  • endothelial cell
  • monocyte
  • macrophages
20
Q

3 Davis’ basic concepts

A
  • First, bone matrix is synthesized by only one cell: the osteoblast.
  • Second, as a result of the polarized synthetic (meaning the synthesis of bone matrix) activity of osteoblasts, bone grows only by apposition.
  • Third, bone matrix mineralizes and has no inherent capacity to “grow.”
21
Q

Distance Osteogenesis

A
  • bone formation occurs on the surfaces of old bone in the peri-implant site
  • The bone surfaces provide a population of osteogenic cells that lay down a new matrix that encroaches on the implant
  • New bone is not forming on the implant, but it does become surrounded by bone.
  • Results in bone approximating the implant
22
Q

Contact Osteogenesis

A
  • No bone is present on the surface of the implant upon implantation
  • New bone forms first on the implant surface.
  • Implant surface has to become colonized by bone cells before bone matrix formation can begin
  • Bone is formed for the first time at the appropriate site by differentiating osteogenic cells surface
  • Results in bone apposition to the implant surface
23
Q

Temporal sequence of healing -THE ANIMAL MODEL

Events leading to: Formation of osseointegration encompassed…

A

coagulum, granulation tissue, development of a provisional matrix, woven bone, parallel-fibered bone and eventually lamellar bone.

24
Q

Osseointegration : Early Events
2 HOURS AFTER IMPLANT INSTALLATION (in animal)

A
  • Threads are in contact with bone - Mechanical anchorage
  • Primary mechanical Stability
  • The void between the pitch and the body of the implant: wound chamber
  • Blood clot characterized by : erythrocytes, neutrophils and monocytes/macrophages in a network of fibrin + leukocytes engaged in the wound cleaning process
  • Blood clot replaced with primitive granulation tissue 4 days after: this tissue contained mesenchymal cells, matrix components and newly formed vascular structures
  • Provisional CT matrix had been established
25
Q

Osseointegration : Early Events
4 DAYS (in animal)

A

ROUGH: In the proximal region an early granulation tissue has formed, whilst in the region close to the device, large numbers of erythrocytes remain

MACHINED: In the area close to the parent bone the clot has been penetrated by vascular structures surrounded by fibroblast-like cells, whereas in the area close to the surface of the device, large numbers of erythrocytes, polymorphonuclear leukocytes and macrophages remain.

26
Q

Osseointegration : Bone Modeling - at 1 week (in animal)

A
  • Provisional CT in the wound chambers rich in vascular structures and mesenchymal cells.
  • A relatively small number of inflammatory cells was still present.
  • A cell-rich immature bone was seen in the provisional CT that surrounded the blood vessels.
  • Woven bone formation occurred in the center of the chamber as well as in discrete locations that apparently were in direct contact with the surface of the titanium device
  • Contact osteogenesis was not observed on polished implant surfaces at this stage
27
Q

Osseointegration : Bone Modeling - at 2 weeks (in animal)

A
  • Woven bone formation was more pronounced in all compartment
  • Woven bone were noticed in the bone marrow regions ‘apical’ of the implant. This osteogenesis took place at a distance from the implant surface and hence was termed ‘distant osteogenesis’.
  • In many regions woven bone was bridging to the surface of the implant.
  • most of the implant surface was occupied by newly formed bone, which formed a continuous coat on the implant surface (i.e. ‘osteocoating’).
  • Osteoclast formation noticed on the pristine bone surfaces, resulting in bone resorption adjacent to the implant surface, especially in areas of pressure of the implant to the bony bed (i.e. pitches of the threads).
  • Mechanical stability replaced by Biological bonding and stability.
28
Q

How many weeks post implant placement does “distant osteogenesis” occur (in animal)?

A

2 weeks

  • Woven bone were noticed in the bone marrow regions ‘apical’ of the implant. This osteogenesis took place at a distance from the implant surface and hence was termed ‘distant osteogenesis’.
29
Q

Osseointegration : Bone Modeling - at 4 weeks (in animal)

A
  • Continuous cell-rich ‘osteocoating’ covered most of the titanium wall of the chamber.
  • The central portion of the chamber was filled with a primary spongiosa, rich in vascular structures and contains a multitude of mesenchymal cells.
30
Q

Osseointegration : Bone reModeling - From 6 to 12 weeks (in animal)

A
  • Most of the wound chambers were now filled with mineralized bone.
  • Bone tissue consisted of primary and secondary osteons
  • Mature bone tissue contact with the implant surface to a very high extent.
  • Bone marrow containing blood vessels, adipocytes and mesenchymal cells was observed to surround the trabeculae of mineralized bone.
  • The bone trabeculae had become reinforced by lamellar or parallel-fiber bone deposition
31
Q

The original Branemark’s protocol recommended strict adherence to surgical and prosthodontic technique:

A
  • “Non-disturbed” healing period of 3-6 months
  • After this healing period, an abutment and suprastructure prosthesis are fabricated and attached to an implant fixture.
32
Q

Today clinicians have 3 loading options:

A
  • Immediate loading – prosthesis connected to the implant fixture within the first 48hrs.
  • Early loading – prosthesis is connected to the implant fixture after the first 48hrs but prior to 3 months.
  • Delayed loading – prosthesis connected to the implant fixture after the initial 3 months.
33
Q

Immediate loading may impose a _________ risk for implant failure when compared to conventional loading, although the survival rates were high for both groups.

A

greater

34
Q

By connecting the implants with the acrylic restoration, we limit the _____________ and therefore, ensuring the osseointegration process

(immediate loading)

A

micro-movements

35
Q

Is bone matrix organization influenced by loading?

A

IL and NL implants showed the same degree of osseointegration. The bone matrix around IL implants had a higher quantity of transverse collagen fibers and presented a higher level of mineralization.

36
Q

Osteotomy can be prepared using 3 methods…

A
  • Sequential drilling —> free osseous debris and microfractured walls —> additional biological energy to repair + resorbed delaying bone modeling contact to the implant.
  • Similarly, blunt osteotome technique leaves loose osseous particles.
  • Piezosurgery leaves a cleaner cavity for implant placement, with very few osseous debris.
37
Q

What is the best preparation technique for bone healing?

A

piezosurgery was most beneficial

38
Q

The insertion torque can be defined as the measurement of the

A

resistance that the implant encounters during its advancement in the apical direction by means of a rotating movement on its axis

> 35 ncm

39
Q

Piezosurgery was more beneficial to use for

A

implant site preparation.

40
Q

Is there an optimal insertion torque for osseointegration to occur around unloaded implants?

A

no significant differences were observed in the way bone heals around implants placed at high vs. low insertion torque

Implants (15 decks)

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