Osseointegration

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History
 Osseointegration- founded by
Professor Per-Ingvar Brånemark
 1950s discovered that bone can
integrate with titanium components

 from the Latin word

 os - bone
 integrate - make whole.
HISTORY CONT’D
 wrought-iron found in a skull
in a French cemetery.

X-rays of the skull

 male believed to have lived
about 1,900 years ago
PRINCIPLE
 A titanium screw-shaped
implant (fixture) is carefully
placed in the bone

 amazingly enough - the genetic

code that commonly makes
bone reject a foreign material
is not activated.
PRINCIPLE CONT’D
 attachment of bone cells to
titanium surface results in firm
anchorage for prosthetic
reconstruction.
Davis's Law
 soft tissue and bone respectively heal
according to the manner in which they
are stressed.
 Healing tissue responds to stress by
reacting along the lines of the given
stress.
 For optimum healing, tissue must be
stressed gradually to accept a given
force.
Wolf's Law
 Making soft tissue accept this
stress during rehabilitation
leadS to strengthening tissue.

 Wolf's Law states that the

same principle applies to
healing bone.
Bone Remodelling

 Bones are living, growing

tissue.

 bone is constantly being

renewed.

 The old bone is removed & the

new bone is laid down
Resorption
 Cells called osteoclasts
dissolve some tissue on the
bone's surface, creating a small
cavity.

 takes place over a few days.

Formation
 osteoblasts fill cavities with
new bone.


 process takes place over a few

months.
USES:
 replace missing teeth

 ears and eyes.

 attach bone-anchored hearing aids

 joint replacements.
drawing of the principles of
osseointegration
 
                                   
Bone Anchored Hearing
Aids (BAHA)
 transmitted to
the hearing
apparatus in ear
through air
 transmitted
through the
bone skull
through bone
conduction.
6 yrs after implant
Implant vs
Osseointerception
 artificial tooth secured into
the jawbone

 allows wearer to eat and

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

 strong posts are attached to

the implants to provide stable
anchors for synthetic
replacement teeth.
 fixtures are inserted under
controlled conditions

 integrate during a 3-6 months

healing period.
a bone cell attaching to titanium
Once osseointegrated
 fixtures connected to prosthetic
replacement

 bone responds by initiating a

continuous process during which it
remodels itself to a state of balance
around the implants.
Osseoperception

 fixtures are inserted under controlled

conditions
 integrate during a 3-6 months healing
period.
 Once osseointegrated, the fixtures
are connected to the prosthetic
replacement
 bone responds by remodels itself to a
state of balance around the implants.
PROBLEMS
 INFECTIONS

 WEAR AND TEAR

 SURGICAL 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
fractured implant head

 The apical portion of

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

 WROUGHT IRON

 TITANIUM
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
affinity

 usually present at 10-100 fold higher

concentration on the cell surface.

 can only bind their ligands when they

exceed a certain minimal number @
focal contacts & hemidesmosomes.
OSSEOINT. BENEFITS
 Same-Day Teeth.
 eliminates discomfort during a
long healing period
 fixtures are inserted in the
morning and
 the final prosthesis is anchored
in the afternoon.
 No rejection