What is osseointegration?

We call osseointegration the process in which the bone joins or heals with the titanium root of a dental implant. It was the Swedish researcher and physician Per-Ingvar Branemark who, through a series of animal studies, discovered that bone tissue has a strong ability to adhere to titanium.

Osseointegration allows the implant to integrate directly, solidly and durably into the jawbone of the maxilla, improving functionality and long-term results.

When a dental implant is placed, the first step is the insertion of the titanium piece into the jawbone. It is then when the osseointegration process begins, which lasts between 3 and 4 months, until the piece is fully integrated with the bone tissue.o. The result is a bone structure that is created around the titanium piece, allowing full functionality to be restored and reducing any discomfort, discomfort or movement of the pieces caused by the absence of teeth. Once osseointegration has been successfully completed, the crowns can be placed.

As you can see, the main benefit of osseointegration is that it achieves a strong fixation of the implant in the jawbone, which allows to recover full functionality and reduce any discomfort, discomfort or movement of the pieces caused by the absence of teeth.

dental implant and crown

Can osseointegration fail?

Dental implant treatment is a very safe treatment and has a high success rate among patients. Specifically, more than 97% of patients, with only a few cases of infection resulting from osseointegration

This failure is commonly known as an implant rejection, although it is not really an incompatibility with the organism, but a poor healing. Even so, they can be caused by poor healing or poor hygiene.

There are some factors that promote the failure of osseointegration, including smoking, certain diseases or poor dental hygiene.

See Rejection of dental implants. What it is and How to avoid it

Why is titanium used in dental implants?

Titanium, due to its physical characteristics, is a highly biocompatible material and integrates perfectly with the bone. This allows a 98% success rate of dental implants to be achieved. In addition, titanium is lightweight and highly resistant to chemical corrosion, thanks to its oxidation layer, which makes it an ideal material to serve as the root of the dental implant in the mouth.

The osseointegration process is favored by roughening the surface of the “implant titanium screw” and coating it with a bioactive agent called hydroxyapatite, which will increase its already very long service life.

There is also another material, zirconium, which has been shown to possess similar bone integration characteristics. But there are still doubts about its evolution over the years, as current studies are still inconclusive.

Types of titanium implants

There are many brands of titanium implants. Most of them are distinguished by the design, osseointegration studies and surface treatment of the dental implant. The success of osseointegration will depend on the treatment of the titanium surface of the implant.

Your implantologist will explain which is the best titanium implant for your case, as well as the available options.

Main types of titanium dental implants:

  • Endoosseous: they are introduced into the alveolar bone and can be of different shapes: friction or threaded, the latter being the most commonly used, since the time required for osseointegration is much shorter.
  • Juxtaosseous: they are used when the mandible presents a high degree of bone resorption and are characterized because they consist of a piece that is mounted on the alveolar ridge and on which the abutment is fixed.
  • Pterygoid: they are mainly used in the rehabilitation of maxillae that present atrophy and are anchored in the so-called pterygoid process of the sphenoid bone (hence its name), which is located above the upper jaw at the level of the second molar.
  • Zygomatic: they are an important option to avoid having to resort to bone grafting when the jawbone shows a high degree of destruction. They are anchored in the zygomatic bone, so their length can be between 35 and 52 millimeters.
  • Drilled plates: they are used when the alveolar bone is too narrow to allow the placement of cylindrical implants. It consists of a sheet of titanium perforated to facilitate bone growth through the holes and in which the abutment is inserted on which the prosthesis is subsequently fixed.

Phases of an osseointegration process

1º Hemostasis: When the bone is drilled to place the screw of an implant, the blood vessels break, causing slight bleeding and a natural response for the area to begin to heal. Some ions and serum proteins begin to adhere to the surface of the titanium implant to seal the broken area in the bone for screw placement.

2nd Inflammation: Blood vessels become more permeable, allowing polynuclear leukocytes to penetrate through the blood vessel walls and enter the wound to clean out the splintered bone matter, tissues and oral bacteria.

3º Proliferation: Around the second week after surgery, a large multinucleated bone cell known as osteoclasts begins to absorb bone tissue, a step that is crucial for the healing phase. As osteoclasts dissolve part of the bone structure with hydrochloric acid, certain by-products are released that are necessary for the formation of new bone tissue.

4th Remodeling: the new lamellar bone structure will begin to remodel in the form of bone structures that connect to the titanium post at right angles. in a way that makes it very receptive to occlusal forces, allowing the implanted tooth to be fully functional.

How an osseointegrated implant is inserted

The osseointegrated dental implant can be placed by means ofimmediate load implantologyand in the event that there are lack of bonea 3D reconstruction of the jaw can be carried out to perform the computer-guided surgery and place implants safely and predictably where there is bone, however minimal.

Check the medical history and bone structure.

In order to obtain as much information as possible before placing a dental implant, a 3D CT scan is performed to analyze the patient’s bone structure, so the operation is virtually planned by combining the CT information with the result of a 3D scan.

A missing tooth means that the dental bone loses its natural stimulus and begins to be resorbed, so it is essential that the implantologist checks that there has been no decrease in bone structure.

When there is little bone, the titanium screw will not have a correct hold. To guarantee the success of the implant, it will be necessary to perform a bone graft to ensure the good anchorage of the implant in the patient’s natural bone.

When a tooth is extracted, the space left by the root that used to occupy that tooth is different depending on the tooth (a canine has only one root, but a molar can have up to three). Therefore, when a dental implant has to be placed in the space previously occupied by a molar tooth, it is necessary to wait for part of the bone to regenerate.

If the extracted tooth had some type of infection, the entire infected area should be cleaned to avoid any inconvenience during osseointegration and to prevent the implant from failing.

Knowing what medications the person is taking, possible allergies or previous illnesses is essential for the proper development of dental treatments.

Depending on the individual circumstances of each patient, the implantologist may prescribe the intake of a drug or antibiotic to avoid complications in the implants during the osseointegration process.

Dental implant placement

  1. First, the titanium root of the implant (screw) is placed, which replaces the root of the natural tooth that has been lost or after the extraction of a damaged tooth.
  2. At 24 h, once the blood clot is established, the osseointegration process begins. The reticular material is formed around the implant, which will mineralize as the days go by. This usually lasts four to six weeks from the time the implant is placed.
  3. The tissue ossifies and adapts to the functional load. This process takes approximately two months.
  4. To check that the healing process is proceeding as planned, the implantologist should periodically check the patient’s mouth.
  5. In a final phase, the bone structure matures and mineralizes properly; this phase will last three to four months. It is then when the provisional teeth fixed on the implants are replaced by the definitive ones.

From these phases we can deduce that the quality of osseointegration improves over time. That is to say, during the first weeks after the implant is placed, there is still no osseointegration. Three months after implant placement, the union between the implant and the bone has already taken place, which becomes firmer and more resistant after six months.

Factors influencing osseointegration

Osseointegration is a biological process that follows its natural course once the implant has been placed in the jaw. There are several factors that influence the duration and effectiveness of the result.

Some of these factors depend on the specific bone physiology of each patient, others have to do with the professional’s ability and the materials used, and others with our habits and the treatment we follow.

  • Smoking has a very negative influence on osseointegration, as it slows down healing and can cause infections in the treated area.
  • Oral hygiene is essential for everyone, but even more so in patients who have just undergone implantology surgery, since infections or oral diseases resulting from poor hygiene can affect osseointegration.
  • Oral hygiene is essential for everyone, but even more so in patients who have just undergone implantology surgery, since infections or oral diseases resulting from poor hygiene can affect osseointegration. The responsible professional should establish the relevant protocols.
  • The type of implant used. As we have seen there are different brands and treatments with different results.
  • In the case of periodontal diseases, these must be fully controlled before proceeding with the implant.

In addition, a surgical procedure with advanced technologies, high quality materials and a surgeon with extensive experience in immediate loading or low-bone implantology procedures can be decisive factors in the success of osseointegration and, consequently, of the implants.

If you want more information about dental implants, contact our dentists in Barcelona at + (34) 669 154 020 and we will inform you without obligation on how to recover your best smile with dental implants. We attend to you in English. A very effective, long-lasting solution, proven in millions of patients worldwide.

Remember that we are a Dental Clinic in Barcelona with great experience in treatments such as:

More information about dental implants:

Types of dental implants. Everything you need to know

Which is better, a prosthesis or a dental implant?

Immediate load implants. What they are and their advantages

What to do if an implant moves

 

 

Dr. Fady Raslan
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