Osseointegration (block 2)

Question 1

2h-12w

Osseointegration according to Berglundh 2003

Answer 1

20 dogs/160 implants 8 implants /dog
Dynamic process
Establshment phse: 2h-6w bone formation <–> resorption
Maintenance phase: 6w-12w Remodeling & function adaptation
2h: COAGULUM, mecchanical stability, chamber w/ ertyth.,neut., fibrin
4d: ANGIOGENESIS, mesenchym.cells, osteoCLASTS on bone, chamber w/ inflamm. cells n vascular structures.
1W: WOVEN BONE, w/ ost.blasts & clasts, collagen, provisional matrix, new bone in contact with SLA surface.
2W: INTENSE bone formation towards chamber, woven bone apical to imp., ost.blasts facing provisional matrix.
4W: SPONGIOUSE bone in chamber, intense remodeling in pithch regions, LAMELLAR bone formation
6W: Chamber filled w/ bone, osteons contact to imp.
8-12W: marked signs of REMODELING, bone MARROW w/ adipocytes vessels & leukocytes.

Question 2

SLA vs T

Explain osseointegration according to Abrahamsson 2004

Answer 2

H/x analysis 2h-12w
Validates Berglundh 2003 & evaluates early bone formation T(turned) vs SLA imp.
20dogs/160 imp. 8/dog
* **BIC% ** ++SLA group 4d~7%, 4w~65% than stablize. -T group peak at 6w~42% BIC.
* Oss.integ. **>rate & >extent **w/ SLA than T surfaces.
* Different PATTERN of bone formation w/ “osteo-coating” of SLA (0-2w)
* After 6-12w NO DIFFERENCE of bone remodeling / adaptation, BUT MORE BIC for SLA (65 vs 42%)

Question 3

Clinical evaluation of the osseointegrated response, according to Albrektsson 1993

Answer 3

• Mobility at the time of the 2° stage surgery or later is indicative of failure
• Rx does not guarantee correct clinical decision making (fibro-integration?)
• Bone height measurements: in the 1° year 1mm of bone loss and then annual BL of 0.1mm
• Lack of information about the long-term bone stability and osseointegration