โดย นทพ.พ�ระย�ทธ อั�สโม 4309050

Osteointegration

Integrate between living bone and surface of an implants

It is for directly structure and function Not to have over loading force or shearing

force Waiting in mand 3 months and 6 months max. Fibrous tissue formation

Paper 1

Immediate Loading of Titanium Plasma-Sprayed Screw-Shaped implants in man: A clinical and histological report of two cases

A.Piattelli, M. Paolantonio, M. Corigliano, and A. Scarano

Journal of periodontal 1997;68:591-597

Material and method

Ten patients----4 males , 6 females Age from 48 to 72 (mean 59) Restoration in edentulous posterior max. and

mand. Arches Three implants were inserted in each of these

patients, for a total of 30. 10 ---- immediately load 20 ---- were allowed to heal in a submerged

location

Material and method

Same day ---- a fixed transitional acrylic prosthetics was put on the implant

Immediated implants were inserted in max. or mand. Premolar region

And submerged were locate posteriorly to it.

Material and method

Material and method

Material and method

Started in November 1994,and checked at 3-month intervals to evaluation…

1. Peri-implant tissues 2. mobility 3. periapical radiographs

Result in first 3 months …no mobility, healthy condition at periapical

tissue, no inflammation

Material and method

It was necessary to retrieve 2 of the loaded implant

1. max.---8 months , fracture of abutment , (case 1)

2. mand.---9 months , psychological reason , (case 2)

Material and method

Histology method

Implants and surrounding tissues were washed in saline solution and immedately fixed in 4 % para-formaldehyde and 0.1 % glutaradehyde in 0.15 M cacodylate buffer at 4 oC and pH 7.4

The specimens…dehydrate with alc. And embeded in a glyclmethacrylate resin

After polymerized specimens…section it in longitudinal axis about 100 um,30 um

Histology method

The slides were stained with acid fuchsin and toluidine blue

Normal transmitted light microsope

Von Kossa staining…done to visualized the calcified structures and their relationship with titanium

Von Kossa… double staining

1. Von Kossa

2. basic fuchsin

Von Kossa

After polishing, the slides were immersed in AgNO3 for 30 min. and exposed to sunlight

The slides were then washed under tap water,dried,and immersed in basic fuchsin for 5 min. ,and then washed and mouthed.

Histology method

Morphometry of percentage of bone contact was done by an optical system connected to an computer

The qualitative analysis of the peri-implant bone was done according to the parameter set in Table.1

Results

Case 1 max. implant Mature,compat,cortial bone was present

around the implant No resorption,bone necrosis The morphometrial analysis showed…the

percentage of bone-implant contact was 72%(+/- 5)

The qualitve analysis was ++++(mature compat bone is present)

Results

Case 1 histological Highly mineralized

present at peri-implant Basic fusin positive At the higher

magnification no gaps were visible in the surface

Results

Results

Case 2

Mature, compact bone with small osteocytic lacunae was present in peri-implant location (fig.13)

No gaps were present at the bone-implant interface

Results

Case 2 no inflamatory cells at interface Histomorphometrical analysis showed…the

percentage of bone-implant contact was 61% (+/- 4)

The qualitve analysis was ++++(mature compat bone is present)

Discussion

Immediate loading implants can be success if primary stability is good with no mobility of implants

Good primary stability come from a precise fit of the implant or a friction related to implants design

Most of the case of immediately loading…were located in mandible

Paper 2

Ultrastructural characterization of the implant/bone interface of immediately loaded dental implants

U. meyer,U.Joos,J.Mythili,T.Stamn ,department of cranio-maxillofacial surgery,university of munster,Germany

Biomaterials 25(2004) 1959-1967 www.elsevier.com/locate/biomaterials

Introduction

Clinic and examination demonstrate that osseointegration can be achieved when healing under load is allowed

Szmukler-Moncler et al. show the relative the timing of loading and effect of micromotion on the bone-implant interface

Micromotion…during the healing process lead to a disruption of the bone-cell-implant contact and lead to deformation of osteoblast that fixed at surface in a strain-related manner

Introduction

The physiological bone loading(500-3000 microstrains)lead to mature bone formation but higher strains make a immature bone formation and fibroblastic cell

The aims of this study … to investigate the features of osteoblast behavior and matrix mineralization during the early bone/biomaterial interaction that depend on implant loading

We have 2 different immediate loading implants on newly titanium implants design

Material and method

Newly developed….. Conical screw-shaped implants A length… 10 mm. A diameter… 4.1 mm. Made from pure Titanium Thread design… the curvature is

well calculated to exhibit a homogenous and physiological strain distribution(1500-3000 microstrains) with in normal under mastigation and loading conditions

Experimental animals

6 male minipigs Minipigs were selected to adequate alveolar

ridge size and hight for implant placement The pigs were sedated with IM injection of…

1. ketamine 10 mg/kg

2. atropine 0.06 mg/kg

3. stresnil 0.03 mg/kg extraction on mand. Second premolar

bilaterally

Experimental animals

Experimental animals

Two groups

2 immediately loaded with in occlusal contact and 2 implants placed in a non-occlusal region

Surgical procedure

The implants inserted by manual tapping of the screw-shaped implants until the bodies were fully embedded in bone

Single crowns were prepared at the day of surgery Dissected a block specimens on days 1,3,14 of

implants loading and embedded it in Tehnovit and subsequent undecalcified histological section

The other block…with implants use SEM to investigation and immunostaining

Section without implants…TEM and diffracton analysis

Transmission electron microscopy

Tissue samples were fixed in 100mM phosphate buffer containing 2.5% glutaraldehyde (pH 7.4)

Specimens were dehydrated in a graded series of alcohol and embedded in Araldite resin

Ultrathin sections were stained for 1 h with 2% uranyl acetate followed by incubation in Reynold’s lead citrat.

Sections were examined under a Philips CM10 electron microscope.

Electron diffraction analysis was carried out on ultrathin sections with a Philips CM10 TEM. Three positions from each implant were usedto investigate the mineral formation.

Transmission electron microscopy

Transmission electron microscopy

x20 x40

Scanning electron microscopy

glutaraldehyde fixed specimens were critical-point dried

Additionally, samples were fixed in liquid nitrogen-cooled propane and cryodriedat 80C.

Samples were sputter-coated with gold for histological analysis (immunogold labeling for the localization of fibronectin,fibronectin receptor, and osteonectin on the surface)

Specimens were examined under a field emission scanning electron microscope (LEO 1530 VP,Oberkochem, Germany).

Scanning electron microscopy

Scanning electron microscopy

Scanning electron microscopy

Scanning electron microscopy

Immunolabeling Cells were incubated with primary antibodies,anti-fibr

onectin, anti-.bronectin receptor, and antiosteonectin(Takara Chemicals, Japan), at a dilution of 1:200.

This was followed by secondary 20 nm gold conjugated antibody incubation (British Bio-Cell International).

After washing a silver enhancement was done for the gold particles using a Silver Enhancement kit(British Bio-Cell International).

The samples were then dehydrated, critical point dried, carbon coated and viewed also through the LEO 1530 VP scanning electron microscope.

Samples without first antibodies were used as controls.

Results

Results

Results

Results

Discussion

A long term success require rigid fixation between implants and host bone site

Axial symmetry is possible Screw-shaped implants effective for achieving

secure implant fixation fibronectin,fibronectin receptor, and

osteonectin on the surface

1. www.pubmed.com2. www.google.com

3. Piattelli A, Paoloantonio M, CoriglianoM Scarano A. Immediate loading of titanium plasma-sprayed screw-shaped implants in man: a clinical andhistologica l report of 2 cases. J Periodontol1997;68:591–7.