Osseointegration

Question 1

“A direct structural and functional connection between ordered,
living bone and the surface of a load-carrying implant”

Answer 1

Osseointegration

Question 2

What are the 6 key factors for successful implant osseointegration?

Answer 2

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

Question 3

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

Answer 3

Titanium

Question 4

____ (decreases the specific weight and improves the elastic
modulus)

Answer 4

• 6% aluminum

Question 5

______: (decreases thermal conductivity and increases the

hardness).

Answer 5

• 4% vanadium

Question 6

: tenacious oxides in air or oxygenated

solutions - Promotes adhesion of osteogenic cells

Answer 6

TITANIUM OXYDE LAYER

Question 7

Should smooth, rough, or moderately rough implant surfaces best for osseointegration?

Answer 7

Moderately rough

Question 8

In order for osseointegration to occur, do you want the surface area to be increased or decreased?

Answer 8

Increased SA

Question 9

A _____ surface roughness
increases the potential for
biomechanical interlocking

Answer 9

greater

Question 10

______ implants surfaces have an higher percentage
of bone implant contact and also an higher torque
removal than machined surfaces.

Answer 10

Rougher

Question 11

What percentage of bone is inorganic?

Answer 11

65-70%

Question 12

What percentage of bone is organic?

Answer 12

30-35%

Type 1 collagen

Question 13

First, bone matrix is synthesized by only one cell: the ______.

Answer 13

osteoblast

Question 14

Second, as a result of the polarized synthetic (meaning the
synthesis of bone matrix) activity of osteoblasts, bone
grows only by _____.

Answer 14

apposition

Question 15

Third, bone matrix _______ and has no inherent capacity

to “grow.”

Answer 15

mineralizes

Question 16

• de novo 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 the latter
does become surrounded by bone.
• Results in bone approximating the implant

Answer 16

Distance osteogenesis

Question 17

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

Answer 17

Contact osteogenesis

Question 18

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

Answer 18

2 HOURS AFTER IMPLANT INSTALLATION

Question 19

(Osseointegration timeline)
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.

Answer 19

4 days

Question 20

(Osseointegration timeline)
• 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 (i.e. woven 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”
• Contact osteogenesis was not observed on polished implant surfaces at this stage

Answer 20

1 week

Question 21

(Osseointegration timeline)
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.
• At this time point of healing, 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).
• After 2 weeks of healing: Mechanical stability replaced by Biological bonding and stability.

Answer 21

2 weekls

Question 22

(Osseointegration timeline)
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.

Answer 22

4 weeks

Question 23

(Osseointegration timeline)
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, thus providing a structure to cope with the bearing of load.

Answer 23

6-12 weeks

Question 24

_______ loading – prosthesis connected to the implant fixture within the first 48hrs.

Answer 24

Immediate loading

Question 25

______ loading – prosthesis is connected to the implant fixture ater the first 48hrs but prior to 3 months.

Answer 25

Early loading

Question 26

______ loading – prosthesis connected to the implant fixture ater the iniral 3 months.

Answer 26

Delayed loading

Question 27

Is immediate loading better for single crowns or larger restorations?

Answer 27

Larger restorations

Question 28

______ (surgical technique) leaves a cleaner cavity for implant placement, with very few osseous debris.

Answer 28

Piezosurgery

Question 29

The ________ can be defined as the measurement of the resistance that the
implant encounters during its advancement in the apical direction by means of a
rotating movement on its axis

Answer 29

insertion torque