Introduction
A successful implant depends on a biological phenomenon called: Osseointegration.
Osseointegration is a concept introduced by Per-Ingvar Brånemark, a Swedish physician and research professor, in 1952.
Definition
Osseointegration is the process by which a rigid and asymptomatic attachment of an alloplastic material is obtained and maintained in the bone.
Factors
1. Biocompatibility
A material is biocompatible when it does not cause physiological problems after being implanted in the organism.
Titanium is the metal most commonly used in implantology.
Its properties are especially suitable for dental implants. When exposed to air, an oxide layer forms rapidly on the surface of the implant and prevents corrosion. This property is what makes titanium biocompatible.
2. Implant design
There are multiple shapes of dental implants. For example:
Screw shape: Placed by screwing
Cylinder shape: by tapping
3. Implant surface quality
The first contact established with the implant surface must be with the blood clot of the implant site.
The contamination of the implant jeopardizes osseointegration.
4. State of the implant site
The quality and the quantity of the remaining bone are crucial factors to consider. A detailed analysis is necessary to ensure the success of the implant.
5. Surgical technique
The surgery must be properly performed to guarantee a successful outcome.
Some guidelines have to be followed. For example:
- Avoid high heat while preparing the site. The critical temperature of the bone is 47° for 1 minute (Low drilling speed (800-2000 t/min) accompanied by irrigation with a physiological serum to cool down the site).
- The insertion must be gentle to prevent resorption.
6. Functional loading of the implant
The implant must be progressively and slowly put to use.
Success criteria
- The implant must be immobile
- Absence of any radiolucent zones (black) around the implant
- The annual vertical bone loss must be < 0,2 mm after the first year of the implant function
- Absence of persisting or irreversible signs or symptoms
Signs and symptoms of failure
- Horizontal mobility greater than 0.5 mm
- Rapid progressive bone loss
- Pain during percussion
- Exudate
- Radiolucency around the implant
Conclusion
Osseointegration is a prerequisite for every successful dental implant. Therefore, respecting the protocol ensures a favorable outcome.
