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Presentacion sobre oseointegracion; historia, tecnicas, etc.
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osseointegration
History
Osseointegration- founded by Osseointegration- founded by Professor Per-Ingvar Brånemark Professor Per-Ingvar Brånemark
1950s discovered that bone can 1950s discovered that bone can integrate with titanium integrate with titanium components components
from the Latin word from the Latin word os - boneos - bone integrate - make whole. integrate - make whole.
HISTORY CONT’D
wrought-iron found in a skull wrought-iron found in a skull in a French cemetery.in a French cemetery.
X-rays of the skullX-rays of the skull male believed to have lived male believed to have lived
about 1,900 years agoabout 1,900 years ago
PRINCIPLE
A titanium screw-shaped A titanium screw-shaped implant (fixture) is carefully implant (fixture) is carefully placed in the boneplaced in the bone
amazingly enough - the amazingly enough - the
genetic code that commonly genetic code that commonly makes bone reject a foreign makes bone reject a foreign material is not activated. material is not activated.
PRINCIPLE CONT’D
attachment of bone cells to attachment of bone cells to titanium surface results in firm titanium surface results in firm anchorage for prosthetic anchorage for prosthetic reconstruction.reconstruction.
Davis's Law
soft tissue and bone respectively heal soft tissue and bone respectively heal according to the manner in which they according to the manner in which they are stressed. are stressed.
Healing tissue responds to stress by Healing tissue responds to stress by reacting along the lines of the given reacting along the lines of the given stress.stress.
For optimum healing, tissue must be For optimum healing, tissue must be stressed gradually to accept a given stressed gradually to accept a given force. force.
Wolf's Law
Making soft tissue accept this Making soft tissue accept this stress during rehabilitation stress during rehabilitation leadS to strengthening tissue. leadS to strengthening tissue.
Wolf's Law states that the Wolf's Law states that the same principle applies to same principle applies to healing bonehealing bone. .
Bone Remodelling
Bones are living, growing Bones are living, growing tissue. tissue.
bone is constantly being bone is constantly being renewed. renewed.
The old bone is removed & the The old bone is removed & the new bone is laid downnew bone is laid down
Resorption
Cells called osteoclasts dissolve Cells called osteoclasts dissolve some tissue on the bone's surface, some tissue on the bone's surface, creating a small cavity. creating a small cavity.
takes place over a few days. takes place over a few days.
Formation
osteoblasts fill cavities with osteoblasts fill cavities with new bone. new bone.
process takes place over a few process takes place over a few months. months.
USES:
replace missing teethreplace missing teeth
ears and eyes. ears and eyes.
attach bone-anchored hearing aidsattach bone-anchored hearing aids
joint replacements. joint replacements.
drawing of the principles of osseointegration
Bone Anchored Hearing Aids (BAHA)
transmitted to transmitted to the hearing the hearing apparatus in apparatus in ear through air ear through air
transmitted transmitted through the through the bone skull bone skull through bone through bone conductionconduction. .
6 yrs after implant
Implant vs Osseointerception artificial tooth secured into artificial tooth secured into
the jawbone the jawbone
allows wearer to eat and allows wearer to eat and speak speak
Osseointerception
tooth root substitutes tooth root substitutes surgically placed in the surgically placed in the jawbone under gum tissue. jawbone under gum tissue.
strong posts are attached to strong posts are attached to the implants to provide stable the implants to provide stable anchors for synthetic anchors for synthetic replacement teeth.replacement teeth.
fixtures are inserted under fixtures are inserted under controlled conditions controlled conditions
integrate during a 3-6 months integrate during a 3-6 months healing period.healing period.
a bone cell attaching to titanium
Once osseointegrated
fixtures connected to prosthetic fixtures connected to prosthetic replacement replacement
bone responds by initiating a bone responds by initiating a continuous process during which it continuous process during which it remodels itself to a state of remodels itself to a state of balance around the implants. balance around the implants.
Osseoperception
fixtures are inserted under controlled fixtures are inserted under controlled conditions conditions
integrate during a 3-6 months integrate during a 3-6 months healing period. healing period.
Once osseointegrated, the fixtures Once osseointegrated, the fixtures are connected to the prosthetic are connected to the prosthetic replacement replacement
bone responds by remodels itself to a bone responds by remodels itself to a state of balance around the implants. state of balance around the implants.
PROBLEMS
INFECTIONSINFECTIONS
WEAR AND TEARWEAR AND TEAR
SURGICAL REMOVALSURGICAL REMOVAL
Placement of 3 implants in the area of tooth #24, 25 and 26. Note the adequate amount of bone available.
3 weeks postoperative staphylococci infection
3 mobile implants removed
8 yrs postop X-Ray: mesial abutment mobile due to a facture of implant head.
Clinical view of the Clinical view of the fractured implant fractured implant head head
The apical portion The apical portion of implant was of implant was osseointegratedosseointegrated
after removal of mesial implant placement of 6 mm diameter 3i implants
materials
WROUGHT IRON WROUGHT IRON
TITANIUMTITANIUM
biomimetic properties
materials must first present cell adhesion motifs .
Another surface modification procedure of value in tissue engineering is the prevention of cell/protein/platelet adhesion to our biomaterial.
such interactions could lead to unfavourable events such as attachment of unwanted cell types and thrombus formation.
Integrins receptor proteins which :
permit cells to bind & respond to the extracellular matrix.
are part of cell adhesion receptors involved in cell-extracellular matrix & cell-cell interactions.
Functional integrins
consist of 2 glycoprotein subunits
1.alpha 2. beta.
receptors contain 1 alpha chain & 1 beta
Cartoon of an integrin
Integrins vs cell-surface receptors
integrins bind their ligands with a low integrins bind their ligands with a low affinity affinity
usually present at 10-100 fold higher usually present at 10-100 fold higher concentration on the cell surface. concentration on the cell surface.
can only bind their ligands when they can only bind their ligands when they exceed a certain minimal number @ exceed a certain minimal number @ focal contacts & hemidesmosomes. focal contacts & hemidesmosomes.
OSSEOINT. BENEFITS
Same-Day Teeth. Same-Day Teeth. eliminates discomfort during a eliminates discomfort during a
long healing period long healing period fixtures are inserted in the fixtures are inserted in the
morning and morning and the final prosthesis is the final prosthesis is
anchored in the afternoon. anchored in the afternoon. No rejectionNo rejection