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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
Chapter

Abstract

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.

Keywords

Dental implant Osseointegration Woven bone Lamellar bone Osteoconduction 

Abbreviations

3 integrin

Alpha (v) beta (3) integrin

BIC

Bone-to-implant contact

BMP

Bone morphogenetic protein

BMU

Basic multicellular unit

CaP

Calcium phosphate

DC-Stamp

Dendrocyte-expressed seven transmembrane protein

FGF

Fibroblastic growth factor

GLAST

Glutamate transport by transporters

HA

Hydroxyapatite

HVC

Haversian canal

IGF

Insulin growth factor

LB

Lamellar bone

LL

Lamellae

M-CSF

Macrophage colony-stimulating factor

NFATc1

Nuclear factor of activated T cells 1

OBM

Organic bone matrix

OSCAR

Osteoclast-associated, immunoglobulin-like receptor

PGE2

Prostaglandin-E2

PGI2

Prostacyclin

RANKL

Receptor activator of nuclear factor kappa-Β ligand

SLA

Sandblasted/acid etched

Src

Proto-oncogene tyrosine-protein kinase

TGF-B

Transforming growth factor beta

WB

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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