By Dr. Aleksandar Trajanoski
After the implant is placed in your jaw, you will have to wait several months for the bone to bond with the implant. This usually takes 3 or 4 months in the lower jaw and 4 or 5 months in the upper jaw. During this time occurs very important process called osseointegration.
Osseointegration, defined as a direct structural and functional connection between ordered, living bone and the surface of a load-carrying implant, is critical for implant stability, and is considered a prerequisite for implant loading and long-term clinical success of end osseous dental implants.
Primary implant stability derives from the mechanical friction of the implant surface with the bone after implant placement. Osseointegration or secondary implant stability requires a highly complex sequence of additional biodynamic processes, this is facilitated by finely tuned communication between the main actors in wound healing the cells. This process has four phases.
First is hemostasis, stopping of the bleeding which happens minutes after implant placement. Inflammatory phase is the second step, where immune cells come to implantation area clean all residues and bacteria preparing the area for new bone formation. This phase is crucial in implant survival, because if some residues or bacteria are left this could sabotage the whole process. In the third phase new blood vessels are formed to bring nutrients for the cells responsible for creating the new bone. Remodeling of new bone occurs in the final phase of osseointegration this remodeling is continues after the implant is put in function.
The successful outcome of any implant procedure is mainly dependent on the interrelationship of the various components of an equation that includes the following :
1. Biocompatibility of the implant material
2. Macroscopic and microscopic nature of the implant surface & designs
3. The status of the implant bed in both a health and a morphologic (bone quality) context
4. The surgical technique per se
5. The undisturbed healing phase
6. Loading conditions
The challenge confronting the clinician is that these several factors must be controlled almost simultaneously, if a predictably successful outcome is to be expected.
After placement, the dental implants should provide initial mechanical stability to prevent movement. Movement between an implant surface and hard tissue causes fibrous capsule formation around the implant. Clinically, encapsulation is prevalent with stainless steel, alumina, zirconia and rarely seen with ccommercially pure Ti implants without movement.
Successful osseointegration is a prequisite for functional dental implants. The osseointegration is a complex process that can be influenced by many factors relating to the surface topography, biocompatibility, and loading conditions all play an important role in osseointegration.
Titanium and its alloys are the materials of choice clinically, because of their excellent biocompatibility and superior mechanical properties. Surface modification technologies involve preparation with either an additive coating or subtractive method. Cell migration, adhesion, and proliferation on implant surfaces are important prerequisites to initiate the process of tissue regeneration, while modifications of the implant surface by incorporation of biologic mediators of growth and differentiation may be potentially beneficial in enhancing wound healing following implant placement.
Technology is constantly advancing, newer, better surfaces are being researched and tested. Modified titanium surfaces may show promising results in the future