Osseointegration: Why is it Vital?
Featured Products Promotional FeaturesPosted by: Dental Design 15th April 2022
Implants originate from early civilisations such as the ancient Egyptians who tried to stabilise teeth using ligatures made from wire and gold. The Etruscans fashioned replacements for teeth from oxen bones and the Mayans excelled in using pieces of shells as implants to replace mandibular teeth.[i] Despite implants having existed for centuries, the dental profession is still perfecting the implant procedure and osseointegration is still something that can present possible challenges.
Methods to Improve Osseointegration
Patients with compromised bone, especially the elderly, are more likely to present challenges when it comes to osseointegration.[ii] The biomechanical characteristics of bone in aged patients and those with type-IV bone are quite similar; even though the survival rate of dental implants is reported to be higher than 90% those with compromised bone can still present challenges.ii Considering this, there are some methods that a clinician can adopt in order to prevent implant failure via osseointegration.
The types of implant used can contribute to success with osseointegration.ii As implant design concepts have developed over the last few decades those that include threads increase the surface area and thereby aid in the accomplishment of bone-implant integration. The geometry of an implant can significantly enhance the initial stability and biochemical fixation of the implant after the healing process.
Surgical techniques are another aspect of implant surgery that can negatively or positively affect the integration of bone and implant. The conventional method of dental implant placement sacrifices a lot of bone tissue through drilling.ii In situations where there is limited bone density, and for good practice, methods have been developed to optimise implant stability without removing excess bone. Undersized drilling has been explored extensively and has resulted in higher insertion torque levels, which indicate improved primary implant stability, and therefore promote success for osseointegration.
Throughout the manufacturing process, companies can also implement physiochemical surface modifications to promote osseointegrationii and improve biological interactions between the host bone and implant surface. Implant surface micro-roughness enlarges the contact area which helps to anchor cells and connect surrounding tissues and there are various methods to achieve this.[iii] Commonly, grit-blasting, acid etching, or combinations of these two methods are used but more recently the modification of the implant surface at nanoscale level has been introduced, though this needs to be explored further. In contrast, the application of bioactive coatings has been explored also and calcium phosphate (CaP) coatings have received great attention due to their chemical similarity to the natural bone mineral.
There are also drug-based methods that can be implemented to enhance the chances of successful osseointegration. These new coating strategies include antiresorptive and anabolic agents and in an experiment, which monitored the progress of bone regeneration in animals with this method, it was shown that bone regeneration significantly increased around the surfaces after four weeks.[iv] As implant surface modifications are implemented by a manufacturer, a dentist will need to be informed enough about what’s on the market and what their patients need to make an informed decision in regards to the best implant for them to work with.
Effects of Failed Osseointegration
Osseointegration can fail for a number of reasons but many times it can come down to lack of planning.[v] A failed implant can cause bone and soft tissue loss which creates the need for major surgical procedures. These procedures can sometimes require an individual to be hospitalised while it’s carried out and will result in more financial costs as well as further discomfort for the patient.
Infection can also lead to failed osseointegration and this can result in bone loss and implant failure.[vi] In turn, the failure of an implant can cause depression for a patient as they may feel that something is wrong with themselves.iii Moreover, a patient may result in having to revert to a non-permanent solution like a removeable denture and this can have a depressive impact on the patient as, for instance, it is a constant reminder of what they have lost.
Working together to find solutions to implant surgery challenges is integral for the overall success of the implant field. That’s why W&H and its sister company Osstell are here for you and your patients with Implantmed. After twenty years of developing technology to support implant surgery, the latest model will not disappoint as it allows the stability of the implant to be measured for reliable restoration. In order to enhance your workflow, it includes an intuitive user interface, secure torque control and the option to add the Osstell ISQ for measurement of implant stability. Plus, with a powerful electric motor, a new pump design, and wireless foot control, the system offers ultimate user convenience. Take a look at the Osstell Beacon for a stand-alone implant stability measurement device. The Osstell ISQ system is supported by over 1200 scientific articles.
To summarise, the challenges of implant surgery are ever present and osseointegration still runs the risk of causing further issues for patients. This is why it is vital to create the ideal conditions for successful integration. Not a single clinician practising today wishes to have to jump hurdles to get to the finish line and that’s why utilising supportive technology will result in better outcomes for everybody.
To find out more visit www.wh.com/en_uk, call 01727 874990 or email office.uk@wh.com
[i] Abraham, Celeste M. “A Brief Historical Perspective on Dental Implants, Their Surface Coatings and Treatments.” The Open Dentistry Journal, vol. 8, no. 1, 16 May 2014, pp. 50–55, www.ncbi.nlm.nih.gov/pmc/articles/PMC4040928/, 10.2174/1874210601408010050. Accessed 18 Oct. 2021.
[ii] Alghamdi, Hamdan. “Methods to Improve Osseointegration of Dental Implants in Low Quality (Type-IV) Bone: An Overview.” Journal of Functional Biomaterials, vol. 9, no. 1, 13 Jan. 2018, p. 7, 10.3390/jfb9010007. Accessed 18 Oct. 2021.
[iii] Schneider, G.B., et al. “Implant Surface Roughness Affects Osteoblast Gene Expression.” Journal of Dental Research, vol. 82, no. 5, May 2003, pp. 372–376, 10.1177/154405910308200509. Accessed 19 Oct. 2021.
[iv] Alghamdi, Hamdan S., et al. “Synergistic Effects of Bisphosphonate and Calcium Phosphate Nanoparticles on Peri-Implant Bone Responses in Osteoporotic Rats.” Biomaterials, vol. 35, no. 21, July 2014, pp. 5482–5490, 10.1016/j.biomaterials.2014.03.069. Accessed 19 Oct. 2021.
[v] Academy of Osseointegration. “The Anatomy of Implant Failures.” Osseo.org, 2021, osseo.org/the-anatomy-of-implant-failures/. Accessed 18 Oct. 2021.
[vi] Raphel, Jordan, et al. “Multifunctional Coatings to Simultaneously Promote Osseointegration and Prevent Infection of Orthopaedic Implants.” Biomaterials, vol. 84, 1 Apr. 2016, pp. 301–314, www.sciencedirect.com/science/article/pii/S0142961216000181?casa_token=i-6qRsifS8wAAAAA:8wtwzfHin9CQyrKjd2RpoJkh7Atf9eAodwrESU215E8xLGBGoa7mOUUJYBbfocjxFmwEHrwL5w, 10.1016/j.biomaterials.2016.01.016. Accessed 19 Oct. 2021.
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