osseointegration

History

Osseointegration- founded by Osseointegration- founded by Professor Per-Ingvar Brånemark Professor Per-Ingvar Brånemark

1950s discovered that bone can 1950s discovered that bone can integrate with titanium integrate with titanium components components

from the Latin word from the Latin word os - boneos - bone integrate - make whole. integrate - make whole.

HISTORY CONT’D

wrought-iron found in a skull wrought-iron found in a skull in a French cemetery.in a French cemetery.

X-rays of the skullX-rays of the skull male believed to have lived male believed to have lived

about 1,900 years agoabout 1,900 years ago

PRINCIPLE

A titanium screw-shaped A titanium screw-shaped implant (fixture) is carefully implant (fixture) is carefully placed in the boneplaced in the bone

amazingly enough - the amazingly enough - the

genetic code that commonly genetic code that commonly makes bone reject a foreign makes bone reject a foreign material is not activated. material is not activated.

PRINCIPLE CONT’D

attachment of bone cells to attachment of bone cells to titanium surface results in firm titanium surface results in firm anchorage for prosthetic anchorage for prosthetic reconstruction.reconstruction.

Davis's Law

soft tissue and bone respectively heal soft tissue and bone respectively heal according to the manner in which they according to the manner in which they are stressed. are stressed.

Healing tissue responds to stress by Healing tissue responds to stress by reacting along the lines of the given reacting along the lines of the given stress.stress.

For optimum healing, tissue must be For optimum healing, tissue must be stressed gradually to accept a given stressed gradually to accept a given force. force.

Wolf's Law

Making soft tissue accept this Making soft tissue accept this stress during rehabilitation stress during rehabilitation leadS to strengthening tissue. leadS to strengthening tissue.

Wolf's Law states that the Wolf's Law states that the same principle applies to same principle applies to healing bonehealing bone. .

Bone Remodelling

Bones are living, growing Bones are living, growing tissue. tissue.

bone is constantly being bone is constantly being renewed. renewed.

The old bone is removed & the The old bone is removed & the new bone is laid downnew bone is laid down

Resorption

Cells called osteoclasts dissolve Cells called osteoclasts dissolve some tissue on the bone's surface, some tissue on the bone's surface, creating a small cavity. creating a small cavity.

takes place over a few days. takes place over a few days.

Formation

osteoblasts fill cavities with osteoblasts fill cavities with new bone. new bone.

process takes place over a few process takes place over a few months. months.

USES:

replace missing teethreplace missing teeth

ears and eyes. ears and eyes.

attach bone-anchored hearing aidsattach bone-anchored hearing aids

joint replacements. joint replacements.

drawing of the principles of osseointegration

                                    

Bone Anchored Hearing Aids (BAHA)

transmitted to transmitted to the hearing the hearing apparatus in apparatus in ear through air ear through air

transmitted transmitted through the through the bone skull bone skull through bone through bone conductionconduction. .

6 yrs after implant

Implant vs Osseointerception artificial tooth secured into artificial tooth secured into

the jawbone the jawbone

allows wearer to eat and allows wearer to eat and speak speak

Osseointerception

tooth root substitutes tooth root substitutes surgically placed in the surgically placed in the jawbone under gum tissue. jawbone under gum tissue.

strong posts are attached to strong posts are attached to the implants to provide stable the implants to provide stable anchors for synthetic anchors for synthetic replacement teeth.replacement teeth.

fixtures are inserted under fixtures are inserted under controlled conditions controlled conditions

integrate during a 3-6 months integrate during a 3-6 months healing period.healing period.

a bone cell attaching to titanium

Once osseointegrated

fixtures connected to prosthetic fixtures connected to prosthetic replacement replacement

bone responds by initiating a bone responds by initiating a continuous process during which it continuous process during which it remodels itself to a state of remodels itself to a state of balance around the implants. balance around the implants.

Osseoperception

fixtures are inserted under controlled fixtures are inserted under controlled conditions conditions

integrate during a 3-6 months integrate during a 3-6 months healing period. healing period.

Once osseointegrated, the fixtures Once osseointegrated, the fixtures are connected to the prosthetic are connected to the prosthetic replacement replacement

bone responds by remodels itself to a bone responds by remodels itself to a state of balance around the implants. state of balance around the implants.

PROBLEMS

INFECTIONSINFECTIONS

WEAR AND TEARWEAR AND TEAR

SURGICAL REMOVALSURGICAL REMOVAL

Placement of 3 implants in the area of tooth #24, 25 and 26. Note the adequate amount of bone available.

3 weeks postoperative staphylococci infection

3 mobile implants removed

8 yrs postop X-Ray: mesial abutment mobile due to a facture of implant head.

Clinical view of the Clinical view of the fractured implant fractured implant head head

The apical portion The apical portion of implant was of implant was osseointegratedosseointegrated

after removal of mesial implant placement of 6 mm diameter 3i implants

materials

WROUGHT IRON WROUGHT IRON

TITANIUMTITANIUM

biomimetic properties

materials must first present cell adhesion motifs .

Another surface modification procedure of value in tissue engineering is the prevention of cell/protein/platelet adhesion to our biomaterial.

such interactions could lead to unfavourable events such as attachment of unwanted cell types and thrombus formation.

Integrins receptor proteins which :

permit cells to bind & respond to the extracellular matrix.

are part of cell adhesion receptors involved in cell-extracellular matrix & cell-cell interactions.

Functional integrins

consist of 2 glycoprotein subunits

1.alpha 2. beta.

receptors contain 1 alpha chain & 1 beta

Cartoon of an integrin

                                                        

Integrins vs cell-surface receptors

integrins bind their ligands with a low integrins bind their ligands with a low affinity affinity

usually present at 10-100 fold higher usually present at 10-100 fold higher concentration on the cell surface. concentration on the cell surface.

can only bind their ligands when they can only bind their ligands when they exceed a certain minimal number @ exceed a certain minimal number @ focal contacts & hemidesmosomes. focal contacts & hemidesmosomes.

OSSEOINT. BENEFITS

Same-Day Teeth. Same-Day Teeth. eliminates discomfort during a eliminates discomfort during a

long healing period long healing period fixtures are inserted in the fixtures are inserted in the

morning and morning and the final prosthesis is the final prosthesis is

anchored in the afternoon. anchored in the afternoon. No rejectionNo rejection