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4309050

Osteointegration
Integrate between living bone and surface of

an implants
It is for directly structure and function
Not to have over loading force or shearing
force
Waiting in mand 3 months and 6 months max.
Fibrous tissue formation

Paper 1
Immediate Loading of Titanium Plasma-

Sprayed Screw-Shaped implants in man: A

clinical and histological report of two cases
A.Piattelli, M. Paolantonio, M. Corigliano, and A.

Scarano

Journal of periodontal 1997;68:591-597

Material and method

Ten patients----4 males , 6 females
Age from 48 to 72 (mean 59)
Restoration in edentulous posterior max. and

mand. Arches
Three implants were inserted in each of these
patients, for a total of 30.
10 ---- immediately load
20 ---- were allowed to heal in a submerged
location

Material and method

Same day ---- a fixed

transitional acrylic
prosthetics was put on
the implant
Immediated implants

were inserted in max. or

mand. Premolar region
And submerged were

locate posteriorly to it.

Material and method

Material and method

Material and method

Started in November 1994,and checked at 3-

month intervals to evaluation

1. Peri-implant tissues
2. mobility
3. periapical radiographs
Result in first 3 months
no mobility, healthy condition at periapical

tissue, no inflammation

Material and method

It was necessary to

retrieve 2 of the loaded

implant
1. max.---8 months ,
fracture of abutment ,
(case 1)
2. mand.---9 months ,

psychological reason ,
(case 2)

Material and method

Histology method
Implants and surrounding tissues were washed in

saline solution and immedately fixed in 4 % paraformaldehyde and 0.1 % glutaradehyde in 0.15 M
cacodylate buffer at 4 oC and pH 7.4
The specimensdehydrate with alc. And embeded in

a glyclmethacrylate resin
After polymerized specimenssection it in

longitudinal axis about 100 um,30 um

Histology method
The slides were stained with acid fuchsin and

toluidine blue
Normal transmitted light microsope
Von Kossa stainingdone to visualized the calcified

structures and their relationship with titanium

Von Kossa double staining
1. Von Kossa
2. basic fuchsin

Von Kossa
After polishing, the slides were immersed in

AgNO3 for 30 min. and exposed to sunlight

The slides were then washed under tap

water,dried,and immersed in basic fuchsin for

5 min. ,and then washed and mouthed.

Histology method
Morphometry of percentage of bone contact was done

by an optical system connected to an computer

The qualitative analysis of the peri-implant bone was
done according to the parameter set in Table.1

Results
Case 1 max. implant
Mature,compat,cortial bone was present

around the implant

No resorption,bone necrosis
The morphometrial analysis showedthe
percentage of bone-implant contact was 72%
(+/- 5)
The qualitve analysis was ++++(mature
compat bone is present)

Results
Case 1 histological
Highly mineralized

present at peri-implant
Basic fusin positive
At the higher
magnification no gaps
were visible in the
surface

Results

Results
Case 2
Mature, compact bone

with small osteocytic

lacunae was present in
peri-implant location
(fig.13)
No gaps were present at
the bone-implant
interface

Results
Case 2
no inflamatory cells at interface
Histomorphometrical analysis showedthe

percentage of bone-implant contact was 61%

(+/- 4)
The qualitve analysis was ++++(mature
compat bone is present)

Discussion
Immediate loading implants can be success if

primary stability is good with no mobility of

implants
Good primary stability come from a precise fit
of the implant or a friction related to implants
design
Most of the case of immediately loading
were located in mandible

Paper 2
Ultrastructural characterization of the

implant/bone interface of immediately loaded

dental implants
U. meyer,U.Joos,J.Mythili,T.Stamn
,department of cranio-maxillofacial
surgery,university of munster,Germany
Biomaterials 25(2004) 1959-1967
www.elsevier.com/locate/biomaterials

Introduction
Clinic and examination demonstrate that

osseointegration can be achieved when

healing under load is allowed
Szmukler-Moncler et al. show the relative the
timing of loading and effect of micromotion on
the bone-implant interface
Micromotionduring the healing process lead
to a disruption of the bone-cell-implant contact
and lead to deformation of osteoblast that
fixed at surface in a strain-related manner

Introduction
The physiological bone loading(500-3000

microstrains)lead to mature bone formation

but higher strains make a immature bone
formation and fibroblastic cell
The aims of this study to investigate the
features of osteoblast behavior and matrix
mineralization during the early
bone/biomaterial interaction that depend on
implant loading
We have 2 different immediate loading
implants on newly titanium implants design

Material and method

Newly developed..
Conical screw-shaped implants
A length 10 mm.
A diameter 4.1 mm.
Made from pure Titanium
Thread design the curvature is
well calculated to exhibit a
homogenous and physiological
strain distribution(1500-3000
microstrains) with in normal under
mastigation and loading conditions

Experimental animals
6 male minipigs
Minipigs were selected to adequate alveolar

ridge size and hight for implant placement

The pigs were sedated with IM injection of
1. ketamine 10
mg/kg
2. atropine 0.06 mg/kg
3. stresnil
0.03 mg/kg
extraction on mand. Second premolar
bilaterally

Experimental animals

Experimental animals
Two groups
2 immediately loaded

with in occlusal contact

and 2 implants placed in
a non-occlusal region

Surgical procedure
The implants inserted by manual tapping of the

screw-shaped implants until the bodies were fully

embedded in bone
Single crowns were prepared at the day of surgery
Dissected a block specimens on days 1,3,14 of
implants loading and embedded it in Tehnovit and
subsequent undecalcified histological section
The other blockwith implants use SEM to
investigation and immunostaining
Section without implantsTEM and diffracton
analysis

Transmission electron microscopy

Tissue samples were fixed in 100mM phosphate

buffer containing 2.5% glutaraldehyde (pH 7.4)

Specimens were dehydrated in a graded series of
alcohol and embedded in Araldite resin
Ultrathin sections were stained for 1 h with 2% uranyl
acetate followed by incubation in Reynolds lead
citrat.
Sections were examined under a Philips CM10
electron microscope.
Electron diffraction analysis was carried out on
ultrathin sections with a Philips CM10 TEM. Three po
sitions from each implant were usedto investigate the
mineral formation.

Transmission electron microscopy

Transmission electron microscopy

x20

x40

Scanning electron microscopy

glutaraldehyde fixed specimens were critical-point

dried
Additionally, samples were fixed in liquid nitrogencooled propane and cryodriedat 80C.
Samples were sputter-coated with gold for
histological analysis (immunogold labeling for the
localization of fibronectin,fibronectin receptor, and
osteonectin on the surface)
Specimens were examined under a field emission
scanning electron microscope (LEO 1530 VP,Oberko
chem, Germany).

Scanning electron microscopy

Scanning electron microscopy

Scanning electron microscopy

Scanning electron microscopy

Immunolabeling
Cells were incubated with primary antibodies,anti-

fibronectin, anti-.bronectin receptor, and antiosteonectin

(Takara Chemicals, Japan), at a dilution of 1:200.
This was followed by secondary 20 nm gold conjugated
antibody incubation (British Bio-Cell International).
After washing a silver enhancement was done for the
gold particles using a Silver Enhancement kit(British
Bio-Cell International).
The samples were then dehydrated, critical point dried,
carbon coated and viewed also through the LEO 1530
VP scanning electron microscope.
Samples without first antibodies were used as controls.

Results

Results

Results

Results

Discussion
A long term success require rigid fixation

between implants and host bone site

Axial symmetry is possible
Screw-shaped implants effective for achieving
secure implant fixation
fibronectin,fibronectin receptor, and
osteonectin on the surface

1. www.pubmed.com
2. www.google.com
3. Piattelli A, Paoloantonio M, CoriglianoM Scarano
A. Immediate loading of titanium plasma-sprayed sc
rew-shaped implants in man: a clinical andhistologi
ca l report of 2 cases. J Periodontol
1997;68:5917.