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Evaluation of Functional Dynamics During Osseointegration And Review Po-Chun Chang Evaluation of functional dynamics Niklaus P. Lang William V. Giannobile during osseointegration and regeneration associated with oral implants Authors’ affiliations: Key words: bone–implant interactions, finite element analysis, growth factor Po-Chun Chang, William V. Giannobile, Department of Periodontics and Oral Medicine, School of Dentistry, University of Michigan, Abstract Ann Arbor, MI, USA Objectives: The aim of this paper is to review current investigations on functional Po-Chun Chang, William V. Giannobile, assessments of osseointegration and assess correlations to the peri-implant structure. Department of Biomedical Engineering, College of Engineering, University of Michigan, Ann Arbor, Material and methods: The literature was electronically searched for studies of promoting MI, USA dental implant osseointegration, functional assessments of implant stability, and finite Po-Chun Chang, Department of Preventive Dentistry, Division of Periodontology, Faculty of element (FE) analyses in the field of implant dentistry, and any references regarding Dentistry, National University of Singapore, biological events during osseointegration were also cited as background information. Singapore Niklaus P. Lang, Faculty of Dentistry, The Results: Osseointegration involves a cascade of protein and cell apposition, vascular University of Hong Kong, Hong Kong, China SAR invasion, de novo bone formation and maturation to achieve the primary and secondary William V. Giannobile, Michigan Center for Oral dental implant stability. This process may be accelerated by alteration of the implant surface Health Research, School of Dentistry, University of Michigan, Ann Arbor, MI, USA. roughness, developing a biomimetric interface, or local delivery of growth-promoting factors. The current available pre-clinical and clinical biomechanical assessments Correspondence to: William Giannobile demonstrated a variety of correlations to the peri-implant structural parameters, and University of Michigan functionally integrated peri-implant structure through FE optimization can offer strong School of Dentistry correlation to the interfacial biomechanics. Michigan Center for Oral Health Research 1011 N. University Ave. Conclusions: The progression of osseointegration may be accelerated by alteration of the Rm. 3305 Dental Bldg. implant interface as well as growth factor applications, and functional integration of peri- Ann Arbor, MI 48109, USA Tel.: þ 1 734 764 1562 implant structure may be feasible to predict the implant function during osseointegration. Fax: þ 1 734 763-5503 More research in this field is still needed. e-mail: [email protected] Osseointegration, which histologically is Stiffness of the tissue–implant interface defined as ‘direct bone-to-implant contact’, and implant-supporting tissues are con- is believed to provide rigid fixation of a sidered as the main determinant factors in dental implant within the alveolar bone osseointegration (Ramp & Jeffcoat 2001). and may promote the long-term success While the structure and heterogeneity of of dental implants (Franchi et al. 2005; mineralization affects the stiffness of bone Joos et al. 2006). The processes of osseoin- (Hoffler et al. 2000), Johansson et al. (1998) tegration involve an initial interlocking demonstrated that biomechanical testing between alveolar bone and the implant may be a more suitable indicator to evalu- Date: body (primary implant stability), and later, ate the dynamic changes of osseointegra- Accepted 16 July 2009 biological fixation through continuous tion than any single structural parameter. To cite this article: bone apposition (contact osteogenesis) However, biomechanical testing, such as Chang P-C, Lang NP, Giannobile WV. Evaluation of functional dynamics during osseointegration and and remodeling toward the implant (sec- push-out and pull-out measurements, is regeneration associated with oral implants. ondary implant stability) (Berglundh et al. destructive and only available for pre- Clin. Oral Impl. Res. 21, 2010; 1–12. doi: 10.1111/j.1600-0501.2009.01826.x 2003). clinical use (Berzins et al. 1997). Therefore, c 2009 John Wiley & Sons A/S 1 Chang et al Á Functional assessment of osseointegration the clinical value of non-destructive mea- itial cell attachment eventually establishes Albrektsson (2009), surface roughness can surements, such as resonance frequency on the implant surface (Kasemo & Gold be divided into four categories (Lang & analysis (RFA) or damping characteris- 1999). The interface area is first occupied Jepsen 2009): tics (Periotests technique, Siemens, Ben- by red blood cells, inflammatory cells, and Smooth surfaces: Sa value o0.5 mm sheim, Germany), are still limited due to degenerating cellular elements, then is gra- (e.g. polished abutment surface). the lower resolution and higher variability dually replaced with spindle-shaped or flat- Minimally rough surfaces: S value during examinations (Aparicio et al. 2006). tened cells, concurrent with initiation of a 0.5–o1 mm (e.g. turned implants). Thus, it is still of interest to develop osteolysis on the host bone surface until Moderately rough surfaces: S value 1– effective approaches to functionally assess day 3 (Futami et al. 2000). Osteoblasts a o2 mm (e.g. most commonly used osseointegration for the evaluation of peri- begin to attach and deposit collagen matrix types). implant wound healing and prognosis of at this stage (Meyer et al. 2004). Rough surfaces: S value 2 mm (e.g. implant therapy. Early bone formation is not evident until a plasma-sprayed surfaces). By reviewing the sequences of osseointe- days 5–7 (Berglundh et al. 2003; Colnot gration and current efforts on promoting et al. 2007) and is consistent with the se- Moderate roughness and roughness is osseointegration, this paper is concentrated quence of appositional matrix deposition associated with implant geometry, such on the scientific significance of pre-clinical and calcification from the lamina limitans as screw structure, and macroporous sur- biomechanical testing and has character- of host bone onto the implant surface face treatments. Previous studies demon- ized the state-of-the-art clinical functional (Marco et al. 2005). Most of the interfacial strated that this type of roughness allowed assessments as well as the model analysis. zone is occupied by provisional matrix rich for bone ongrowth and provided mechan- According to the development of modern in collagen fibrils and vasculature, and ical interlocking shortly after implant pla- medical imaging techniques and mechan- woven bone can be observed around the cement (Berglundh et al. 2003; Franchi ical modeling, the relationship between vascular areas by day 7 (Berglundh et al. et al. 2005). Higher bone–implant contact structural and biomechanical parameters 2003). Through continuous deposition, tra- (BIC) and removal torque force suggested were also described. becular bone fills the initial gap and ar- enhanced secondary stability compared ranges in a three-dimensional (3D) with smooth and minimally rough im- network at day 14 (Franchi et al. 2005). plants (Buser et al. 1991; Wennerberg et al. Timing of osseointegration The de novo formation of primary bone 1996). spongiosa offers not only a biological fixa- There are two main theories regarding While it has been demonstrated that ex- tion to ensure secondary implant stability the influence of implant surface microto- cessive mobility may cause fibrous tissue (Ferguson et al. 2006) but also a biological pography on peri-implant tissue formation formation and lead to failure of osseointe- scaffold for cell attachment and bone de- – (1) the surface energy and (2) the distor- gration (Huiskes et al. 1997; Lioubavina- position (Franchi et al. 2005). After 28 tional strain. The smaller grain size on the Hack et al. 2006), in order to limit the days, delineated bone marrow space and surface results in higher surface energy, micromotion and achieve primary stability thickened bone trabeculae with parallel- which is more favorable for cell adherence of the implant, a slightly undersized os- fibered and lamellar bone can be found (Kilpadi & Lemons 1994; Kim et al. 2008). teotomy is usually prepared for press-fit- within the interfacial area. After 8–12 Bowers et al. (1992) first demonstrated that ting of the implant. However, a 60 mm weeks, the interfacial area appears histolo- the moderate roughness with sandblasted gap between the implant and host bone has gically to be completely replaced by mature and acid-etching treatments significantly been noted under microscopic investiga- lamellar bone in direct contact with tita- promoted cell attachment. Anselme & tions (Futami et al. 2000; Colnot et al. nium (Berglundh et al. 2003). Bigerelle (2005) later investigated long- 2007), and depending on the extent of term osteoblast adherence and behavior injury to the host bone, this gap may later in vitro and demonstrated that a low am- extend to 100–500 mm (Eriksson et al. Implant surface alteration to plitude of the surface roughness induced 1984). Therefore, this gap is filled with accelerate osseointegration cell spreading more intimately than the blood and forms a water layer incorporated rougher one. Therefore, the microtopogra- with hydrated ions on the implant surfaces The chemical composition or charges of phy of the implant surface also influences immediately after implant placement (Park the implant interface on the implant sur- differentiation events by providing the dis- & Davies 2000; Berglundh et al. 2003). face
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