The essential conditions of success of the implantation. Biocompatibility. Osseointegration.

Transcription

1 Department of ral and Maxillofacial Surgery he essential conditions of success of the implantation. Biocompatibility. sseointegration. Dr. Kinga Bérczy Semmelweis University, Faculty of Dentistry

2 Conditions of success of oral implants Biocompatibility Gingival seal ptimal transmission of masticatory forces

3 Parts of the human body replaceable with biomaterials

4 Function of oral implants claims great mechanical and biological demands

5 erms used for the evaluation of biomaterials Biocompatibility

6 Biocompatibility

7 erms used for the evaluation of biomaterials Biocompatibility Biomechanical functional ability

8 Biomechanical functional ability:

9 erms used for the evaluation of biomaterials Biocompatibility Biomechanical functional ability Biological stability Corrosion Biodegradation Metallosis

10 Biocompatibility Biomechanical functional ability Metals

11 11 From the periodical chart of elements the non cytotoxic metals: 1 H 2 He 2 Li 4 Be 5 Na 6 C 7 N 8 9 Na 10 Ne 11 Na 12 Mg 13 Al 14 Si 15 P 16 S 17 Cl 18 Ar 19 K 20 Ca 21 Sc 22 i 23 V 24 Cr 25 Mn 26 Fe 27 Co 28 Ni 29 Cu 30 Zn 31 Ga 32 Ge 33 As 34 Se 35 Br 36 Kr 37 Rb 28 Sr 29 Y 40 Zr 41 Nb 42 Mo 43 c 44 Ru 45 Rh 46 Pd 47 Ag 48 Cd 49 In 50 Sn 51 Sb 52 e 53 I 54 Xe 55 Cs 56 Ba * 71 Lu 72 Hf 73 a 74 W 75 Re 76 s 77 Ir 78 Pt 79 Au 80 Hg 91 l 82 Pb 83 Bi 84 Po 85 At 86 Rn 87 Fr 88 Ra ** 27 Co 103 Rf 105 Co 106 Sg 107 Bh 108 Hs 109 Mt 110 Uun 111 Uuu 112 Uub 114 Uuq i Zr Nb a Pt itanium, Zirconium, Niobium, antalum, Platinium

12 Classification of biomaterials /sborn 1979/ Biotolerant materials steel alloys Cr-Co-Mo alloys /Vitallium/ plastic materials Bioinert materials tantalum, titanium, niobium aluminium oxide ceramics carbon compounds Bioactive materials

13 Classification of biomaterials /sborn 1979/ Biotolerant materials steel alloys Cr-Co-Mo alloys /Vitallium/ Bioinert materials plastic tantalum, titanium, niobium, aluminium oxide ceramics, carbon compounds Bioinert materials tantalum, titanium, niobium aluminium oxide ceramics carbon compounds Bioactive materials bioglass hydroxyapatite

14 Classification of biomaterials /sborn 1979/ Biotolerant materials steel alloys Cr-Co-Mo alloys /Vitallium/ plastic Bioinert materials tantalum, titanium, niobium, aluminium oxide ceramics, carbon compounds Bioinert materials titanium tantalum, titanium, niobium aluminium oxide ceramics carbon compounds Bioactive materials bioglass hydroxyapatite tricalcium phosphate

15 Material composition of commercially pure /CP/ titanium recommended for dental implants: itanium 99.75% Iron 0.05% xygen 0.10% Nitrogen 0.03% Carbon 0.05% Hydrogen 0.012%

16 he material composition of titanium alloys recommended for oral implants i 6Al 4V i 5Al 2,5Fe i 6Al 7Nb

17 uter surface of titanium implant Electrolyte xide layer itanium

18 Forms of titanium oxide i i 2 i 2 3 i x y anatase brookite rutile

19 he healing and remodeling of bone around osseointegrated implants (James, McKinney 1982) peration on bone, implant placement

20 Surgical access, flap preparation Marking drilling (max rpm) Marking drilling (max rpm) Pilot drilling

21 Controls Widening drilling I. (two step drill) Widening drilling II. (spiral bur) he place of the implant in the bone

22 Implant placement I. Implant placement II. Implant placement III. Placing the healing screw into a two phase implant

23 Placement of a one-part implant

24 wo-part implant, two-stage surgery

25 he healing and remodeling of bone around osseointegrated implants (James, McKinney 1982) peration on bone, implant placement Healing process of bone, cellular reactions forming the implantbone interface

26 i i i i i i i i i i i i i i i i i i Metal surface, metal bond delocalised electrons Dipole zone itanium oxide i 2 i i 2 3 i 2

27 Ions, serum proteins fibrin Ca 2 + fibrin Ca 2+ fibrin Ca 2+ fibrin Ca2+ fibrin i i i i i i i i i i i i i i i i i itanium i i 2 oxide i 2 i 2 3 Ca 2+ i

28 fibrin Ca 2 + fibrin Ca 2+ fibrin Ca 2+ fibrin Ca2+ fibrin Biofilm i i i i i i i i i i i i i i i i i itanium i i 2 oxide i 2 i 2 3 Ca 2+ i

29 Appearance of mesenchymal cells, their transformation into osteoblasts Collagen - matrix itanium i i 2 oxide i 2 i 2 3

30 he scheme of transformation of bone forming cells Undifferentiated mesenchymal cells (in the walls of minor vessels) Fibroblast Fibrocyte steoblast steoclast SECYE

31 Proliferation of vessels Collagen - matrix itanium i i 2 oxide i 2 i 2 3

32 Formation Formation of osteoid of (reticular lamellar bone tissue) Kollagén - matrix itanium i i 2 oxide i 2 i 2 3

33 he dynamic oxid interface he oxid surface is a dynamic system, which creates an interchange with the molecules of the surrounding tissues

34 Molecular bonds on the implant surface VAN DER WAAL KÖÉSEK (1-10 kcal/mol) BIMLECULE XYGEN BNDS (1-10-kcal/mol) BIMLECULE CVALEN BNDS (1-100 kcal/mol) Importance of purity of the implant surface Molecular contamination of the implant surface Molecular bonds= Electrokinetic potential

35 he healing and remodelling of bone around osseointegrated implants /James, MacKinney1982/ peration on bone, implant placement Healing process of bone, cellular reactions forming the implant-bone interface Formation of mature lamellar bone, remodelling of periimplant bone tissue

36 SSEINEGRAIN Direct contact between implant and bone at light microscopic level P.I.Branemark 1969, 1977

37 sseointegration is an accidental finding by Professor Per-Ingvar Brânemark /Sweden/ and his collegues during the 1950s and1960s. heir vital microscopic studies with titanium observation chambers,gave the finding of the great adherence of metal to the bone. /Worthington Ph., et al:sseointegration in Dentistry, Quintessence 1994./

38 SSEINEGRAIN Direct contact between implant and bone at light microscopic level

39 Electromicroscopic studies revealed, that osteoblast-like cells were separated from the oxide surface by a thin layer of proteoglycan and amorphous zone /with thickness up to 400 nm/ /Linder L., et al. Acta rthop. Scand.1983/

40 Connection between the implant and the neighbouring tissues Gingival seal sseointegration

41 Exsudative, proliferative phase (days 1-14) Formation of reticular bone (weeks 2-6) Formation of lamellar bone and remodelling (weeks 6-18)

42 he healing and remodelling of bone around osseointegrated implants (James, McKinney 1982) peration on bone, implant placement Healing process of bone, cellular reactions forming the implant-bone interface Formation of mature lamellar bone, remodeling of periimplant bone 3-6 mon ths

43 Recent studies

44 Stages of peri-implant endosseous healing /John E.Davies:J.Dent.Educ / steoconduction- Migration of osteogenic cells to the implant surface de novo bone formation /modeling/ Bone remodeling

45 Stages of peri-implant endosseous healing Depends on the microtexture /John E.Davies:J.Dent.Educ / steoconduction- migration of odontogenic cells to the implant surface Growth Blood clot- factors fibrin accelerate adherence- the platelet vascular activation proliferation, /cytokines, activate growth factors/ the mesenchymal cells hrombogenic properties of titanium /hor A.et al.: Biomaterials 2007/

46 sseointegration on the implant surface /sborn JF.,Newesely H.1980,Davies JE. 2005/ A: Machined surface : B: Microtextured surface : bone formation bone formation on the surface on the surface of the pristine bone of the implant

47 he rate of the new bone formation /animal studies/ Distance stogenesis: µ/day Contact steogenesis: µ/day /Abrahamsson et al. 2004/

48 Stages of peri-implant endosseous healing /John E.Davies:J.Dent.Educ / steoconduction- migration of odontogenic cells to the implant surface de novo bone formation /modeling/ 3. 1.Mesenchymal 2. Final Reticular, stage of woven the cells bone transform to osseointegration preosteoblasts, then osteoblasts developes around the developement the implant of mineralized lamellar bone around Developement the implant of extracellular matrix

49 HE CNDIINS F SSEINEGRAIN Atraumatic, aseptic operation Bioinert or bioactive material Proper implant surface Primary stability Undisturbed (unloaded) healing?

50 he human histological examinations of osseointegration may raise serious ethical

51 Unloaded aluminium- oxide ceramic implant

52 Implant removed together with the surrounding bone

53 Healed maxilla after the removal of the implant

54 Histological image of the removed implant, 20x magnification

55 Histological image 50x magnification Implant bo marrow ne

56 Histological image; implant at 100x magnification bone marrow

57 he bone-implant-contact /BIC/, can be measured by histomorphometric investigations, and expressed in percentage /%/.

58 BIC can be regarded as the measure of osseointegration, thus determines the load bearing of implant prosthesis

59 hank you your attention!