Osseointegration Applications

Transcription

1 Osseointegration Applications Dr. Dora-Lisa Juhnke Orthopaedic Research Fellow at Macquarie University and the Australian School of Advanced Medicine M. Al Muderis, A. Kumar, T. Boesel, S. Chan, S. Laux, S. Benson, C. Basten, F. Barnett, J. Martin, B. Bosley

2 Disclosures None

3 History of Osseointegration a Story of Losses

4 Ancient History 3000 BC the Egyp6ans used shaped ivory to replace lost teeth* 2000 BC the Chinese used bamboo wedges for the same cause* 2 nd century: a jaw of a Gallo- Roman shows an iron dental implant** The Mayans from Central America used shells to form ar6ficial teeth*** * Dental Implant Prosthe6cs, 1e; Carl E. Misch, Ch. 3, fig 3-1 ** Nature 394, 534 (6 th of August 1998) *** Textbook of Oral and Maxillofacial Surgery, Balagi Ch.15, p

5 Central America Honduras Playa de los Muertos In 1931 Dr. Wilson Popenoe led a team on a Mayan archaeology site and excavated a mandible

6 First Evidence of Osseointegration 20 year old women, 7 th century Amadeo Bobbio, 1972 Textbook of Oral and Maxillofacial Surgery, Balagi Ch.15, p

7 Modern History 1700s 1800s Lost teeth were o_en replaced with teeth from human donors - > mostly unsuccessful due to immune system reac6ons Gold, pla6num and other metal alloys were experimentally placed into sockets where teeth had been freshly extracted - > Long- term success rates were extremely poor Per- Ingvar Brånemark in Sweden accidentally discovered that 6tanium can bond irreversibly with living bone 6ssue The process of purposely implan6ng 6tanium in bone for the purpose of roo6ng prosthe6c teeth began The Toronto Conference on Osseointegra6on in Clinical Den6stry created the first guidelines for what would be considered successful implant den6stry. Textbook of Oral and Maxillofacial Surgery, Balagi Ch.15, p

8 1 st Indication: Tooth Loss Physiologic: - Loss of baby teeth Pathologic: - Disease Caries - Age Parodontitis - Trauma Sport Surgery/ Orthodontics

9 Current Dental Implants

10 Numbers Implant den+stry market value 2011: 3.5 billion AUD 2020: billion AUD CAGR : 6-8% In million dental implants were inserted in the US (15-20% of all people affected by tooth loss had an implant) In 2020 it is es6mated to be 2-4 million dental implants (25-30% of all people affected) In 2010 there were 158,000 den6sts that insert implants In ,000 den6sts do the same job Straumann estimates; IHS Global Insight; American Dental Association, 23 Health Policy Resources Center, 2010 ADA Dental Workforce Model

11 2 nd Indication: Craniofacial Loss Facial defects caused by Disease (i.e. skin cancer, head and neck cancer) Birth defects (i.e. microtia, anophthalmia) Trauma (i.e. outer ear trauma, nose trauma)

12 Orbital

13 Nose

14 Auricular

15 Congenital 3 rd Indication: Hearing Loss - Atresia - Chromosmal syndroms/ Malformation Acquired - Cerumen - Foreign objects - Infection (middle/ outer ear) - Perforated eardrum (accidental/ infection) - Otosclerosis - Exostoses/ Tumors - Bone trauma

16 Bone Anchored Hearing Aid Abutment transfers sound vibrations from processor to implant Sound processor picks up sound vibrations Osseointegrated titanium implant inside bone; transfers sound vibrations to functioning cochlea based on bone conduction

17 4 th Indication: Limb Loss

18 Osseointegrated Upper Limb Prostheses Thumb 10 cases Prosthe6c Ortho6c Int 2011 June; Osseointegra6on amputa6on prosthesis on the upper limbs; Methods, prosthe6cs and rehabilita6on 35 (2), p

19 Osseointegrated Upper Limb Prostheses Fingers

20 Osseointegrated Upper Limb Prostheses Trans-radial/ Trans-humeral 10 cases cases Prosthe6c Ortho6c Int 2011 June; Osseointegra6on amputa6on prosthesis on the upper limbs; Methods, prosthe6cs and rehabilita6on 35 (2), p

21 Osseointegrated Lower Limb Prostheses Trans-tibial / Trans-femoral OPRA Swedish ILP/ Endo-Exo German

22 Achievements Direct structural connection between living bone and the surface of an artificial implant Stable fixa6on Cosme6c benefits Func6onal benefits Hearing Weight Bearing Osseopercep6on Moving Chewing

23 Contraindications for Osseointegrated Applications There are no absolute contraindications for all of them, however each one needs special consideration and precaution!!! Fujimoto T, Niimi A, Nakai H, Ueda M: Osseointegrated implants in a patient with osteoporosis: a case report, Int J Oral Maxillofac Implants Jul-Aug;11(4): Javed F, Romanos GE: Impact of diabetes mellitus and glycemic control on the osseointegration of dental implants: a systematic literature review, J Periodontol Nov;80(11): Aschoff HH, Clausen A, Hoffmeister T: The endo-exo femur prosthesis-a new concept of bone-guided, prosthetic rehabilitation following above-knee amputation, Z Orthop Unfall Sep-Oct;147(5):610-5.

24 Precautions for Osseointegrated Applications - Diabetes - Peripheral Vascular Disease - Lack of Compliance - Poor Hygiene - Osteonecrosis - Osteoporosis - Growing Skeleton - Substance abuse including - Medication (i.e. bisphosphonates) - Smoking + other contraindications for surgery (haematologic problems, age, malignant disease, HIV etc.)

25 - Diabetes Precautions for Osseointegrated Applications Osseointegrated Limb prostheses Other Applications Javed F, Romanos GE: Impact of diabetes mellitus and glycemic control on the osseointegration of dental implants: a systematic literature review, J Periodontol Nov;80(11): Aschoff HH, Clausen A, Hoffmeister T: The endo-exo femur prosthesis-a new concept of bone-guided, prosthetic rehabilitation following above-knee amputation, Z Orthop Unfall Sep-Oct;147(5):610-5.

26 Precautions for Osseointegrated Applications - Peripheral Vascular Disease Osseointegrated Limb prostheses Other Applications Aschoff HH, Clausen A, Hoffmeister T: The endo-exo femur prosthesis-a new concept of bone-guided, prosthetic rehabilitation following above-knee amputation, Z Orthop Unfall Sep-Oct;147(5):610-5.

27 Precautions for Osseointegrated Applications - Lack of Compliance - Poor Hygiene Insufficient Stoma Care -> Every Osseointegrated Application Hwang D, Wang HL: Medical contraindications to implant therapy: part I: absolute contraindications, Implant Dent Dec;15(4): Hwang D, Wang HL: Medical contraindications to implant therapy: part II: relative contraindications, Implant Dent Mar;16(1): Aschoff HH, Clausen A, Hoffmeister T: The endo-exo femur prosthesis-a new concept of bone-guided, prosthetic rehabilitation following above-knee amputation, Z Orthop Unfall Sep-Oct;147(5):610-5.

28 Precautions for Osseointegrated Applications - Osteonecrosis of jaw bone Dental Implants - associated with taking of bisphosphonates Lazarovici TS, Yahalom R, Taicher S, Schwartz-Arad D, Peleg O, Yarom N: Bisphosphonate-related osteonecrosis of the jaw associated with dental implants, J Oral Maxillofac Surg Apr;68(4): Bedogni A, Bettini G, Totola A, Saia G, Nocini PF: Oral bisphosphonate-associated osteonecrosis of the jaw after implant surgery: a case report and literature reviewj Oral Maxillofac Surg Jul;68(7):1662-6

29 - Osteoporosis Precautions for Osseointegrated Applications Dental Implants Fujimoto T, Niimi A, Nakai H, Ueda M: Osseointegrated implants in a patient with osteoporosis: a case report, Int J Oral Maxillofac Implants Jul-Aug;11(4): Hwang D, Wang HL: Medical contraindications to implant therapy: part II: relative contraindications, Implant Dent Mar;16(1): 13-23

30 Precautions for Osseointegrated Applications - Growing Skeleton Dental Implants Osseointegrated Limb Prostheses Facial Prostheses Aschoff HH, Clausen A, Hoffmeister T: The endo-exo femur prosthesis-a new concept of bone-guided, prosthetic rehabilitation following above-knee amputation, Z Orthop Unfall Sep-Oct;147(5):610-5 Hwang D, Wang HL: Medical contraindications to implant therapy: part II: relative contraindications, Implant Dent Mar;16(1): 13-23

31 Precautions for Osseointegrated Applications - Substance abuse including - Medication (i.e. bisphosphonates, chemotherapy) - Smoking Every Osseointegrated Application Hwang D, Wang HL: Medical contraindications to implant therapy: part II: relative contraindications, Implant Dent Mar;16(1): Aschoff HH, Clausen A, Hoffmeister T: The endo-exo femur prosthesis-a new concept of bone-guided, prosthetic rehabilitation following above-knee amputation, Z Orthop Unfall Sep-Oct;147(5):610-5.

32 Up to now no Osseointegrated Applica6on for Memory Loss Loss of Interest