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PubMed2006

Osseointegration and mechanical stability of pyrocarbon and titanium hand implants in a load-bearing in vivo model for small joint arthroplasty.

PURPOSE: To test the mechanical stability and histologic osseointegration under load-bearing conditions of 2 different materials, pyrocarbon (Py) and titanium (Ti), in a rabbit model. METHODS: Proximal interphalangeal implants (9 Ti, 8 Py) were placed into rabbit knees and the animals were killed after 3 months. Subsidence was assessed by monthly x-rays. Mechanical stability was measured with a nondestructive pullout test. Implant osseointegration was evaluated by an analysis of the relative implant-calcified bone contact surface on microradiographs and by a histomorphometric analysis of the percentage of bone and connective tissue contact with the implant surface. Histologic examination included assessment of bone apposition on the basis of fluorochromes. RESULTS: Subsidence was found in all 8 Py implants but in none of the Ti group. All 9 Ti implants were mechanically stable; all 8 Py implants were loose. A significantly higher implant-bone contact was found for the Ti group compared with the Py group. Bone apposition increased with time and was highest for the Ti implants 6 weeks after implantation. CONCLUSIONS: In the rabbit model osseointegration of implants was highly dependent on the material. A reliable osseointegration was found for Ti implants. For Py implants no osseointegration or implant stability was achieved. For use of small joints of the hand we therefore recommend Ti-based implants.

Animals↗
PubMed2003

[Oromandibular reconstruction with free peroneal flap and osseointegrated implants].

Free fibula flaps have proved to be one of the most versatile for oromandibular reconstruction due to the available length of bone and the possibility of incorporating a long skin paddle to cover intraoral soft tissues. The use of a osseointegrated dental implants is an important technique for the oral rehabilitation of these patients. Osseointegrated implants provide the most rigid prosthetic stabilization available to withstand masticatory forces. These implants can be placed immediately or in second time procedure. In our case, implantation in the fibula free flap is done after 6-9 months because of the large amount of osteosynthesis material required for the fixation of the flap. Four or six months later, when osseointegration has taken place, the implants are loaded with a dental rehabilitation. We analize 10 cases of mandibular reconstruction with fibula free flap and their aesthetic and functional rehabilitation with osseointegrated implants with a 2 year follow up. Forty-six dental implants were placed developing all of them but one a correct osseointegration. All these patients recovered masticatory function and underwent a considerable improvement in labial competence, salivary continence, speech articulation and facial harmony.

Adult↗
PubMed1998

A comparative study of osseointegration of titanium implants in autogenous and freeze-dried bone grafts.

PURPOSE: This study was undertaken to compare the rate and degree of osseointegration of dental implants when placed into either autogenous corticocancellous chip or freeze-dried corticocancellous chip bone grafts. MATERIALS AND METHODS: The canine ilium was used as the model site. Thirty experimental and 15 control implants were placed in 15 dogs: autogenous versus freeze-dried corticocancellous chip bone grafts around the exposed implant surfaces. In addition to the placement of control implants, the apical portion of the grafted implants acted as their own control. The implants were harvested at 1, 2, and 3 months. The evaluation of the integration process was performed by means of light microscopy, microradiography, and histomorphometry. RESULTS: Using this model, the results indicate that at 1 month there was no statistical difference in the degree of osseointegration in the two bone grafts. At 2 months, there was a statistically greater degree of osseointegration noted in the autogenous corticocancellous chip sites than in the freeze-dried bone grafts. At 3 months, the degree of osseointegration in the two groups was 70% and 33%, respectively. At 3 months, there was virtually 100% integration with trabecular bone at the control implant sites. CONCLUSION: The results indicate that at 2 months postoperatively implants placed in an autogenous bone chip graft osseointegrate to a significantly greater degree than implants placed in a freeze-dried bone chip graft, and this difference remains at 3 months.

Animals↗
PubMed1997

Bone morphogenetic protein-2 for peri-implant bone regeneration and osseointegration.

Recombinant human bone morphogenetic protein-2 (rhBMP-2) induced bone regeneration and osseointegration was evaluated in supraalveolar peri-implant defects in 5 beagle dogs. Alveolar bone was reduced 5 mm in height in mandibular premolar areas and the premolars were extracted. Three 10 mm titanium fixtures were placed 5 mm into each reduced alveolar crest, leaving 5 mm in a supraalveolar position. Alternate quadrants in consecutive animals received a surgical implant consisting of 2 ml rhBMP-2 (0.43 mg/ml) in a type I bovine collagen carrier, or the carrier alone (control). Fixtures and surgical implants were submerged under the gingival flaps. The healing interval was 16 weeks. Histometric and radiographic evaluations were made. Defect height averaged (+/- SD) 5.3 +/- 0.2 and 5.1 +/- 0.2 mm for rhBMP-2 and control defects, respectively (P > 0.05, n = 5, paired, t-test) Bone regeneration (height) averaged 4.2 +/- 1.0 and 0.5 +/- 0.3 mm for rhBMP-2 and control defects, respectively (P < 0.05). Bone regeneration (area) averaged 6.1 +/- 6.3 and 0.2 +/- 0.2 mm2 for rhBMP-2 and control defects, respectively (P > 0.05). Osseointegration within the confines of the defect averaged 19.1 +/- 10.1% and 8.2 +/- 4.6% for rhBMP-2 and control defects, respectively (P > 0.05). Osseointegration within regenerated bone averaged 29.1 +/- 9.8% and 65.3 +/- 15.3% for rhBMP-2 and control defects, respectively (P < 0.05). Osseointegration within the retained alveolar bone averaged 67.1 +/- 4.6% and 68.1 +/- 3.6% for rhBMP-2 and control defects, respectively (P > 0.05). The results suggest that there is a potential for rhBMP-2 induced bone regeneration and osseointegration in surgical peri-implant defects.

Alveolar Process↗
PubMed1997

Osseointegration enhanced by chemical etching of the titanium surface. A torque removal study in the rabbit.

Roughened implant surfaces are thought to enhance osseointegration. Torque removal forces have been used as a biomechanical measure of anchorage or osseointegration in which the greater forces required to remove implants may be interpreted as an increase in the strength of osseointegration. The purpose of this study was to compare the torque resistance to removal of screw shaped titanium implants having an acid etched (HC1/H2SO4) surface (Osseotite) with implants having a machined surface. Two custom screw shaped implants, 1 acid etched and the other machined, were placed into the distal femurs of 10 adult New Zealand White rabbits. These implants were 3.25 mm in diameter x 4.00 mm in length without holes, grooves or slots to resist rotation. Following a 2 month healing period, the implants were removed under reverse torque rotation with a digital torque measuring device. Two implants with the machined surface preparation failed to achieve osseointegration. All other implants were found to be anchored to bone. Resistance to torque removal was found to be 4 x greater for the implants with the acid etched surface as compared to the implants with the machined surface. The mean torque values were 20.50 +/- 6.59 N cm and 4.95 +/- 1.61 N cm for the acid etched and machined surfaces respectively. The results of this study suggest that chemical etching of the titanium implant surface significantly increases the strength of osseointegration as determined by resistance to reverse torque rotation.

Acid Etching, Dental↗
PubMed1999

Polymetallism and osseointegration in oral implantology: pilot study on primate.

In oral implantology, successful results in osseointegration are obtained in the medium term (6-12 months) with commercially pure titanium implants. However, current superstructures can be of a different nature (precious metal or titanium) and of different manufacture (cast or machine-produced). Polymetallism between the implant and the superstructure may lead to conditions of galvanic corrosion, and influence osseointegration. The study described establishes, on the one hand, the procedures of animal experimentation in primates and on the other, the techniques of analysis of histological sections. The first technique of analysis is based on histomorphometry and leads to the definition of an osseointegration index. The second technique of analysis consists of X spectrometry by dispersion of energy which enables a spectral analysis of selected points below the crestal neck of the implant (vulnerable area in the case of corrosive attack) to be obtained. It is noted that after 6months, two of which were of activation, osseointegration did not vary according to the nature of the superstructure (precious alloy or titanium). After 2 months, the presence of a precious alloy superstructure lead to titanium migration towards the area around the cervical region of the implant (10-50 microm). This phenomenon did not occur with a titanium implant. It can therefore be presumed that polymetallism leads to detectable corrosion after 2 months but without apparent modification of osseointegration.

Analysis of Variance↗
PubMedDate not supplied

[Improved osseointegration and periprosthetic bone volume around cementless metal implants under bisphosphonate treatment].

AIM: The effects of a systemic treatment with the bisphosphonate ibandronate on osseointegration of uncoated and hydroxyapatite-coated titanium implants and on periprosthetic bone volume have been evaluated and the dosage of medication had to be defined. METHOD: We used an animal model of the rat, the animals were assigned to three treatment groups receiving 1 microg, 5 microg and 25 microg/kg body weight and one control group receiving NaCl 0.9%. An uncoated and a hydroxyapatite-coated titanium rod were inserted into the medullary canal of the femur. After 28 days the specimens were harvested and histomorphometric evaluation revealed extend of osseointegrated implant surface and changes of periprosthetic bone volume. RESULTS: Treatment groups receiving 5 microg and 25 microg ibandronate showed significant improvement of osseointegrated implant surface compared to the control group. Enhancement of periprosthetic bone volume was revealed in all treatment groups but only application of 25 microg ibandronate was significantly improved compared to the control group. CONCLUSION: A minor dose of 1 microg ibandronate is not effective to improve osseointegration. A high dosed bisphosphonate treatment with 5 microg or 25 microg ibandronate is potent to improve osseointegrated implant surface significantly compared to an untreated control in both uncoated and hydroxyapatite-coated titanium implants and to enhance periprosthetic bone volume. By that, improved secondary stability and prolonged survival time of cementless metal implants can be expected.

Animals↗
PubMed2000

Osseointegrated proximal interphalangeal joint prostheses with a replaceable flexible joint spacer--long-term results.

Osseointegrated proximal interphalangeal joint prostheses with a replaceable joint spacer were used in 25 joints in 19 patients (five men and 14 women) aged 45 (16-67) years. Indications for surgery were post-traumatic arthrosis (nine joints in eight patients), primary osteoarthrosis (10 joints in eight patients), and rheumatoid arthritis (six joints in three patients). A silicone joint spacer was attached to titanium fixtures by short titanium stems that extended from the spacer and fitted into a central canal in the screws. The arthroplasty was done in one stage, which included resection of the joint followed by grafting of marrow and cancellous bone from the iliac crest into adjacent medullary cavities before insertion of the titanium fixture. Follow up at 8.5 (5-11) years showed that 47 out of 50 fixtures (94%) had successfully osseointegrated while 17 of 25 joint spacers (68%) had fractured. However, because of the design of the prostheses fractured joint spacers could easily be replaced and a new spacer could be connected to already osseointegrated screws. The joint spacer was replaced in 11 fingers once or several times. Range of movement (ROM) in the whole series (four fusions excluded) was 41 (0-85) degrees with an extension defect of 15 (0-55) degrees. In eight joints with permanently intact joint spacers the ROM was 39 (0-60) degrees with extension defects of 16 (0-40) degrees. In six joints in which the spacer was replaced once the ROM was 43 (0-85) degrees with an extension defect of 16 (0-55) degrees. Our data confirm good long-term osseointegration of titanium fixtures and that a joint spacer, if needed, can be replaced by a new spacer that can be attached to already osseointegrated screws without jeopardizing the ROM.

Adolescent↗
PubMed2006

Stepwise introduction of a bone-conserving osseointegrated hip arthroplasty using RSA and a randomized study: I. Preliminary investigations--52 patients followed for 3 years.

BACKGROUND: We developed a total hip system using osseointegration guidelines, a metaphyseal-loading proximal femoral replacement in the retained neck and a dual-geometry titanium shell in the acetabulum. PATIENTS AND METHODS: A randomized controlled clinical trial was undertaken in 52 patients (53 hips), using the cemented Spectron stem and cementless Harris-Galante II cup as control implants (24 patients in experimental group, 29 control patients). Clinical measures of Harris Hip Score (HHS), pain score and radiostereometric analysis (RSA) at regular intervals for up to three years were used to monitor progress. RESULTS: No statistically significant differences were found in HHS and pain score; the stability of the cementless experimental implant was also comparable to that of the cemented controls by RSA. 3 revisions were required for migration in the experimental group and 1 was required for component dislocation in the control group. INTERPRETATION: Our findings indicate the practicality of osseointegration of titanium implants, but suggest that current performance is inadequate for clinical introduction. However, the stable fixation achieved in the retained neck in the majority of patients is indicative of osseointegration. This finding will encourage technical and design improvements for enhancement of clinical osseointegration and should also encourage further study. Periprosthetic osteolysis might be avoided by the establishment and maintenance of direct implant-bone connection: "osseointegration".

Acetabulum↗
PubMed2002

Osseointegrated alloplastic ear reconstruction with the implant-carrying plate system in children.

Osseointegration biotechnology has revolutionized ear prosthetic retention, and the benefits of osseointegrated alloplastic ear reconstruction have been well documented. The aim of this study is to present the authors' clinical experience with the implant-carrying plate system (EPITEC System) in children. For 3.5 years, 14 microtia patients (13 boys and one girl, ages 6 to 16 years) were treated with osseointegrated prosthetic ear reconstruction. A total of 30 titanium implant posts of the system were used; one of the patients had bilateral defects. Implant posts were inserted into a three-dimensional carrier plate, which was fixed by means of screws to the mastoid. All patients were operated on using a one-stage procedure allowing 2 to 3 months for osseointegration, followed by fabrication of the ear prostheses. After follow-up, which varied from 6 to 42 months for each patient, all implants that could be monitored were found to be stable. A total of 21 implant posts remained free from potentially dangerous skin reactions. The soft tissues around five of the implant posts in three patients were hypertrophied. One patient was lost to follow-up. The results suggest that the implant-carrying plate system offers several advantages in children: (1) Location of the implants is independent of the recipient bone available; (2) no apparent submergence is evident; (3) additional anchoring is achieved by newly formed bone growing over and covering the connecting bars of the three-dimensional carrier plate, which is only 1 mm thick; and (4) osseointegration is highly successful. Because of the limited number of cases represented in this article, along with a rather limited observation period, this study is preliminary. For a final evaluation, a longer observation time is needed. Despite this, the authors believe that a one-stage procedure with the system in the mastoid process in children can be recommended.

Adolescent↗
PubMed2006

Radiographic signs of osseointegration in porous-coated acetabular components.

UNLABELLED: There currently is no direct method to radiographically determine osseointegration of an uncemented, porous-coated acetabular component. We defined five radiographic signs for detecting acetabular osseointegration: (1) absence of radiolucent lines; (2) presence of a superolateral buttress; (3) medial stress-shielding; (4) radial trabeculae; and (5) an inferomedial buttress. We assessed their ability to predict acetabular osseointegration by reviewing the postprimary and prerevision radiographs from a series of 119 total hip arthroplasties that had revision surgery. Each sign had a high positive predictive value for the presence of bone ingrowth (range, 92.2-96.3%). The absence of radiolucent lines, presence of superolateral buttresses, and presence of medial stress-shielding were the most sensitive signs for indicating bone ingrowth. Ninety-seven percent of the cups with three to five signs were bone ingrown, whereas 83% of the cups with one or no signs were unstable. When three or more signs were present, the positive predictive value of the radio-graphic test was 96.9%, the sensitivity was 89.6%, and the specificity was 76.9%. The five signs of acetabular osseointegration reliably predicted osseointegration, especially when used in combination. They can be used as a tool for radio-graphically assessing the status of patients with porous-coated uncemented cups. LEVEL OF EVIDENCE: Diagnostic study, Level III (Study of nonconsecutive patients; without consistently applied reference "gold" standard). See the Guidelines for Authors for a complete description of levels of evidence.

Acetabulum↗
PubMed2006

A numerical approach to resonance frequency analysis for the investigation of oral implant osseointegration.

Experimental devices based on vibration testing are employed as non-destructive procedures for evaluating implants osseointegration. Their behaviour was evaluated considering the outcome of numerical analysis. The purpose was to use the finite element method for assessing the ability of frequency analysis in detecting the degree of oral implant osseointegration. A three-dimensional model of a mandible was obtained from tomographic survey. A single implant was considered in canine region. Two configurations were analysed, with and without a mass linked to the implant as a cantilever, reproducing experimental devices. Simulation consisted of analysing the response to impulse forces for different osseointegration levels, thus evaluating the biomechanical efficiency of the implant-bone compound. A good correlation between frequency response and osseointegration level was obtained. This was carried out by providing an impulse excitation of the implant that resulted in a vibration pattern. Within the limit of finite element analysis, the outcomes showed that numerical investigation provides understanding the behaviour of testing devices based on frequency measurements, confirming the potential of vibrations technique as non-invasive analysis for osseointegration process.

Biomechanical Phenomena↗
PubMedDate not supplied

Intramedullary osseointegration: development of a rodent model and study of histology and neuropeptide changes around titanium implants.

A rodent model has been developed to explore intramedullary osseointegration and the phenomena of osseoperception. Osseointegration with endosseous titanium implants is frequently used in oral surgery. More recently, intramedullary osseointegration has been used for direct skeletal anchoring of amputation prostheses, a procedure that provides for a stable prosthesis with improved perception. Experimental, commercially pure titanium rods with threaded ends were surgically implanted in the intramedullary space of 18 rat femurs, and were left in place for 8 wk. Microscopic and immunohistochemical observation of the titanium/bone interface at this time-point indicated successful osseointegration with normal remodeled bone adjacent to the fixture. Calcitonin gene-related peptide activity was upregulated during the process of bone remodeling, and there was no significant inflammatory reaction. There was new, normal bone adjacent to and fully occupying the space between fixture threads. Innervation also appeared normal in remodeled bone, as indicated by immunohistochemical observation of small nerve fibers with the antibody Protein Gene Product 9.5 (PGP 9.5). The model will be used further to explore intramedullary osseointegration and osseoperception in connection to clinical applications.

Animals↗
PubMed1997

Chronodynamic evaluation of the stages of osseointegration in zirconium laminar implants.

Osteogenesis occurs throughout all stages in life, due to both bone turnover and reparative processes. Thus, osseointegration (OI) can be described as the final step in a cascade of processes involved in bone healing in relation to implants. Ten groups of 5 Wistar rats each (mean = 90 g b.w.) were used. Under ether anesthesia a zirconium laminar implant was placed in the tibia following the method previously described by our laboratory (Cabrini et al Imp Dent 2:264-7, 1993). The animals were killed at Ohs, and 1, 2, 3, 6, 7, 10, 12, 14, and 60 days post-implantation. Tibiae were resected, radiographed and processed for their embedding in methyl methacrylate. Three sections, perpendicular to the major axis of the tibia, were obtained per implant and histologic and histomorphometric studies were carried out. Volume occupied by blood clot, woven bone, percentage of OI and OI bone tissue thickness, were determined. Histologic and histomorphometric studies as function of time revealed: a) at 6 days the presence of non-osseointegrated woven bone around the device is evident increasing in volume from 7 to 10 days post-implantation, and disappearing from day 12 to 14., b) at 14 days after implantation lamellar bone formation on the surface of the zirconium implants (OI) is noticeable. Additional bone growth is observed after 60 days. This study enables quantification of peri-implant reparative process response in an unloaded, necrotic trabeculae free model showing, in the different phases of the osseointegration process, the role of the blood clot and of the appearance and disappearance of woven bone and the final stages of osseointegration. Further investigation will allow comparison of results obtained under the effect of local and/or systemic factors that might affect osseointegration.

Animals↗
PubMed2005

[Clinical application of osseointegration for auricular defects and deformity].

OBJECTIVE: To investigate the clinical value of osseointegration for repairing auricular defects and deformity. METHODS: Twenty cases (21 ears) including congenital and non-congenital auricular defects and deformity, were treated with osseointegrated prostheses according to the manual of Branemark implanting system. The first-stage operation was for osseointegration of implants, and the second-stage was for anchoring the prostheses. All cases were followed up for six months to three years. RESULTS: One-time success rate is 100%. Satisfactory rate of appearance recovery is 90.47%. The infection rate between osseointegrated implants and surrounding tissue is 14.28%. The stability rate of prostheses is 100%. CONCLUSIONS: It has a good result to apply osseointegrated prostheses for repairing auricular defects and deformity.

Adolescent↗
PubMed1990

[Criteria for determining clinical success with osseointegrated dental implants].

In the past decade, the technique of osseointegration has elicited three general responses in the dental profession. The first and major response has been an enormous clinical satisfaction to resolve difficult prosthetic problems, as well to expand the scope and range of routing prosthetic therapy. A second, if minor, response has been an attempt to deny the documented apparent superiority of the osseointegrated method. The third response has been a very active marketing one, which led to the rapid proliferation of a large number of implant systems, all claiming osseointegration and comparable success to the originally introduced Swedish system. The purpose of this paper is to describe and analyze those clinical criteria which can be used by dentist and researcher to determine the long term success or failure of functioning dental implants. Some attempts had been made to identify criteria which reflected sound scientific consideration of long term host acceptance of functioning implants. However, these criteria where a reflection of the state of the art information as perceived by the authors at the time. It is therefore fair to add that the principle of osseointegration did not feature in our colleagues recommendations. Since it is an axiom that host response must be analyzed and understood if a clinical technique is to be successfully prescribed, we regarded our own and other's published data on clinical results with osseointegration as pivotal in the grouping of criteria which would comprise a reliable yardstick, easy to identify and apply, and which reflected assessment experiences in dental practice and research, mainly in the disciplines of periodontics and prosthodontics.(ABSTRACT TRUNCATED AT 400 WORDS)

Dental Implantation, Endosseous↗
PubMed1997

Osseointegration & stress shielding.

Forty-two patients with a flexible distal non-cemented grit-blast hip stem have been examined to see if distal osseointegration (OI) had occurred. The minimum follow-up was 5 years. The definition of distal osseointegration was "the exhibition of distal bone hypertrophy with proximal bone atrophy with no radiolucency in a clinically stable situation". Osseointegration was noted in 28.6%. It was seen more commonly in older females with greater canal fill, especially in the lateral x-ray. A control group in which the distal end of the stem was polished showed virtually no osseointegration. It appears therefore that with the simple expedient of polishing the distal stem, osseointegration in this zone can virtually be abolished.

Adult↗
PubMed1997

Osseointegration in cortical sheep bone of calcium phosphate implants evaluated by PIXE method and histology.

Osseointegration of porous calcium phosphate ceramics evolves in several stages once implanted. Histologic analysis has often been used to evaluate the mechanism of integration of this material. Histologic parameters can be completed by physical analysis to obtain a semiquantitative evaluation of the osseointegration process. The histologic observation of hydroxyapatite (HA)-ceramic-containing bone sections was associated with proton-induced X-ray emission (PIXE) analysis and the results obtained by both methods were compared. Porous HA-ceramic cylinders were implanted in cortical bone of sheep femurs for periods ranging from 2 to 36 weeks. Thick sections of the implant containing bone were made at the end of the implantation period. A scanning line with two proton impacts 0.5 mm apart was plotted from the edges of cortical bone across the implanted ceramic and the X-rays produced were determined. Calcium, phosphorus, zinc, strontium, and iron contents were measured. Following PIXE analysis, the sections were surface-stained and observed under a light microscope to define the osseointegration index. Two regions of the curves were identified for each element characterizing either the bone tissue or the ceramic. Zinc and strontium present in the bone tissue but absent from the ceramics appeared after the 8th and the 12th implantation weeks, respectively. Iron present in the implant decreased with time, and calcium and phosphorus contents tended to be the same at the end of the implantation period in both curve regions. Histologic observation showed that immature bone invaded the pores of the outer layer of the ceramic as early as 2 weeks after implantation. Ceramics were totally osseointegrated 20 weeks after implantation. Osseointegration was apparently still evolving as judged by the PIXE method when histologic integration was considered complete.

Animals↗