Basic Bone Biology Healing During Osseointegration of Titanium Dental Implants

  • David Soto-Peñaloza
  • José Javier Martín-de-Llano
  • Carmen Carda-Batalla
  • Miguel Peñarrocha-Diago
  • David Peñarrocha-OltraEmail author


Dental implants can be integrated at both hard and soft tissue levels. Osseointegration is a dynamic process during its establishment and maintenance, characterized by resorption and apposition events, and the extent and degree of osseointegration is in part affected by implant surface configuration. It is marked by three distinct healing stages during endosseous implant integration: osteoconduction, “de novo” bone formation, and bone remodeling, which occur by the interaction of different bone cells: osteocytes, osteoblasts, and osteoclasts. One of the most important aspects for reaching clinical osseointegration is the primary stability during implant placement. The extent of primary anchorage is tightly related to native bone characteristics, implant design, patient characteristics, and surgical technique, respectively, where they all regulate to some extent the strain applied to mineralized tissue and directly related to bone interfacial stress and frictional force transferred, which is clinically interpreted as insertion torque. At 2 weeks there is an evident accelerated proliferation of blood vessels and mesenchymal cells embedded inside the provisional granulation tissue that stimulate the formation of an immature peri-implant primary bone or woven bone. At 4 weeks, the woven bone replacement by lamellar bone suggests an initial remodeling has begun, and it is evidenced by the presence of primary osteonic structures that elucidate the onset of woven bone remodeling toward lamellar bone configuration surrounding blood vessels. At 8 weeks, the healing chambers clearly show a “bone remodeling” process, with the presence of parallel fibered lamellar bone deposition, and there is plenty of bone formed, evidenced by the presence of primary and secondary osteonic structures. Lamellar osteons (haversian systems) outlined by cement-line boundaries are visible.


Dental implant Osseointegration Woven bone Lamellar bone Osteoconduction 


3 integrin

Alpha (v) beta (3) integrin


Bone-to-implant contact


Bone morphogenetic protein


Basic multicellular unit


Calcium phosphate


Dendrocyte-expressed seven transmembrane protein


Fibroblastic growth factor


Glutamate transport by transporters




Haversian canal


Insulin growth factor


Lamellar bone




Macrophage colony-stimulating factor


Nuclear factor of activated T cells 1


Organic bone matrix


Osteoclast-associated, immunoglobulin-like receptor






Receptor activator of nuclear factor kappa-Β ligand


Sandblasted/acid etched


Proto-oncogene tyrosine-protein kinase


Transforming growth factor beta


Woven bone


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Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • David Soto-Peñaloza
    • 1
  • José Javier Martín-de-Llano
    • 2
  • Carmen Carda-Batalla
    • 2
  • Miguel Peñarrocha-Diago
    • 1
  • David Peñarrocha-Oltra
    • 1
    Email author
  1. 1.Oral Surgery Unit, Department of Stomatology, Faculty of Medicine and DentistryUniversity of ValenciaValenciaSpain
  2. 2.Department of Pathology and Health Research Institute of the Hospital Clínico (INCLIVA), Faculty of Medicine and DentistryUniversity of ValenciaValenciaSpain

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