In Vivo Bone Response to Biomechanical Loading at the Bone/Dental-Implant Interface

Abstract

Since dental implants must withstand relatively large forces and moments in function, a better understanding of in vivo bone response to loading would aid implant design. The following topics are essential in this problem. (1) Theoretical models and experimental data are available for understanding implant loading as an aid to case planning. (2) At least for several months after surgery, bone healing in gaps between implant and bone as well as in pre-existing damaged bone will determine interface structure and properties. The ongoing healing creates a complicated environment. (3) Recent studies reveal that an interfacial cement line exists between the implant surface and bone for titanium and hydroxyapatite (HA). Since cement lines in normal bone have been identified as weak interfaces, a cement line at a bone-biomaterial interface may also be a weak point. Indeed, data on interfacial shear and tensile "bond" strengths are consistent with this idea. (4) Excessive interfacial micromotion early after implantation interferes with local bone healing and predisposes to a fibrous tissue interface instead of osseointegration. (5) Large strains can damage bone. For implants that have healed in situ for several months before being loaded, data support the hypothesis that interfacial overload occurs if the strains are excessive in interfacial bone. While bone "adaptation" to loading is a long-standing concept in bone physiology, researchers may sometimes be too willing to accept this paradigm as an exclusive explanation of in vivo tissue responses during experiments, while overlooking confounding variables, alternative (non-mechanical) explanations, and the possibility that different types of bone (e.g., woven bone, Haversian bone, plexiform bone) may have different sensitivities to loading under healing vs. quiescent conditions.

Bone ingrowth on the surface of endosseous implants. Part 1: Mathematical model

“…Assuming that bone healing in bone-implant gaps proceeds as in the small holes, which is quite reasonable from the examples of the literature (Brunski, 1999), and that the approximate ratio in the bone healing time between rabbits and humans is 1:3 (Roberts, 1988), we should expect a value of v w close to 1.0 after 18 weeks of healing. Rough estimates based on Eq.…”

“…For a detailed description of the process we refer the reader to Davies (2003); Marco et al (2005); Puleo and Nanci (1999); Brunski (1999); Joos et al (2006) and the extensive number of references therein, from which the following description has been extracted.…”

“…Actually, key information about the biomechanical and biological function of bone implants is still lacking. As far as biomechanics is concerned, perhaps the only well-established fact is the relation between excessive early micromotion and the formation of a fibrous capsule instead of an osseointegrated interface (Pilliar et al, 1986;Sφballe et al, 1992a,b;Brunski, 1999;Cullinane et al, 2003). The information about the influence of the frequency, amplitude and type of loading on new bone formation is nevertheless still incomplete, despite abundant in vitro and in vivo experimental works (Szmukler-Moncler et al, 1998;Pavlin and Gluhak-Heinrich, 2001).…”

Knowledge and Acceptance of Dental Implant Treatment in General Public in Delhi Population

“…[6][7] For professionals, it is vital to assess their level of knowledge with regards to dental implants and whether their perception of dental implants does in fact reflect reality. [8][9] Replacement of missing or lost teeth with dental prostheses supported by implants has been accepted and rated as a positive experience by patients who have undergone implant treatment. [9][10] Many studies have been carried out in different parts of the world with regards to the awareness of dental implants as a treatment option.…”

Immediately loaded implants in a patient with involuntary mandibular movements: A clinical report

“…[1][2][3] Patients are often highly satisfied with a fixed immediate prosthesis in the mandible. 4 The success has been well documented and has been shown to be influenced by bone volume and the initial stability of the implants [1][2][3]5,6 Clinical studies on immediate and early loading have shown the survival rates of implants in the mandible to range between 90% and 100%. [1][2][3]7 Selecting edentulous patients for an immediate occlusal load prosthesis should include careful consideration of risk factors.…”