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The Biology of Dental Implants

The Biology of Dental Implants. James Q. Swift, DDS Division of Oral and Maxillofacial Surgery University of Minnesota. Concepts of Connective Tissue Healing Around Implants. Osseous Integration / Osseointegration Fibrous Integration Fibro-osseous Integration. Bone Healing.

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The Biology of Dental Implants

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  1. The Biology of Dental Implants James Q. Swift, DDS Division of Oral and Maxillofacial Surgery University of Minnesota

  2. Concepts of Connective Tissue Healing Around Implants • Osseous Integration / Osseointegration • Fibrous Integration • Fibro-osseous Integration

  3. Bone Healing • Phase I: Inflammatory Phase • Phase II: Proliferative Phase • Phase III: Maturation Phase

  4. Phase I Bone Healing: Day 1-10 • Absorption of plasma proteins • Platelet aggregation and activation • Clotting cascade activation • Cytokine release

  5. Phase I Bone Healing: Day 1-10 • Nonspecific cellular inflammatory response • Specific cellular inflammatory response • Macrophage mediated inflammation

  6. Phase II Bone Healing: Day 3-42 • Neovascularization • Differentiation, proliferation and activation of cells • Production of immature connective tissue matrix

  7. Phase III Bone Healing: After Day 28 • Remodeling of the immature connective tissue matrix with coupled resorption/ deposition of bone • Bone remodeling in response to implant loading • Physiologic bone recession

  8. Mucoperiosteal Healing • Phase I: Inflammatory Phase • Phase II: Proliferative Phase • Phase III: Maturation Phase

  9. Phase I Mucoperiosteal Healing Inflammatory Phase: Day 1-10 • Platelet aggregation and activation • Clotting cascade activation • Cytokine release • Nonspecific cellular inflammatory response • Macrophage mediated inflammation

  10. Phase II Mucoperiosteal Healing Proliferative Phase: Day 2-42 • Neovascularization • Differentiation, proliferation and activation of cells • Deposition of immature collagen, elastin, and ground substance

  11. Phase III Mucoperiosteal Healing Maturation Phase: After Day 21 • Connective Tissue Remodeling

  12. Bone Implant Interface • Dependent on implant material • Calcified bone, unmineralized osteoid matrix, and connective tissue • Zone of amorphous material • Proteoglycans and glycosaminoglycans • 100-3000 angstroms • Collagen filaments

  13. Chemical Bonds Between Bone and Implants • van der Waals • Local direct chemical bonds (ionic, covalent) • Chemical bonding well described with calcium phosphate ceramics • Some materials have no chemical bond but have excellent bone contact • (CP titanium vs. HA)

  14. Factors Affecting Healing • Surgical technique • Premature loading • Surgical fit • Extraction sites

  15. Factors Affecting Healing • Peri-implantitis • Bone quality • Staged healing

  16. Logic CONTROL

  17. STUDY DESIGN 3 Healing Groups Experiment Control 12 Pigs 6 Pigs Healing Healing 1 Month 1 Month 2 Month 2 Month (4) (4) 4 Month 4 Month (4) (4) (4) (4) 5 Months Non-Loading 5 Months Controlled Loading

  18. Radio-Subtraction (S3D, MDRCBB) One Month Healing Four Months Healing

  19. Micro-CT Images Four Months Two Months One Month

  20. Stevenel’s Blue and Van Gieson’s Picro-Fuchsin Stain Four Months Two Months One Month

  21. Issues Relating to Physical Status of Recipient • Nutritional status • Age • Hematologic issues

  22. Issues Relating to Physical Status of Recipient • Diabetes • Corticosteroids • Radiation

  23. 51 year old man • CC- “I ‘ve been referred for evaluation and treatment for a growth in my jaw” • HPI • 2 month duration • mobile teeth • facial swelling

  24. 51 year old man • PMH • Hypertension-well controlled • PDH • Imaging findings • 4 cm x 2 cm radiolucent lesion left mandibular body causing tooth displacement

  25. 51 year old man • Problem list • Radiolucent lesion • Teeth vital • Buccal plate perforation • No paresthesias • Differential diagnosis • ameloblastoma • central giant cell lesion • odontogenic myxoma

  26. 51 year old man • Treatment plan • Incisional biopsy for histologic typing • Prosthodontic consultation • Definitive imaging (CT scan) • Biopsy results • Acanthomatous ameloblastoma

  27. 51 year old man • Treatment • Arch bars/surgical stent construction • Transcervical approach for exposure and lateralization of IAN/Mental nerve • Transoral marginal resection preserving inferior border • Reconstruction plate applied for stabiliation

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