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ssBioMed CentHead & Face Medicine
Open AcceEditorial
New paradigm in implant osseointegration
Ulrich Joos1 and Ulrich Meyer*2
Address: 1Klinik und Poliklinik für Mund-, Kiefer- und Gesichtschirurgie, Universitätsklinikum, Westfälische Wilhelms-Universität, Münster,
Waldeyerstr. 30, 48129 Münster, Germany and 2Klinik für Kiefer- und Plastische Gesichtschirurgie, Westdeutsche Kieferklinik, Moorenstrasse 5,
40225 Düsseldorf, Germany
Email: Ulrich Joos - joos@uni-muenster.de; Ulrich Meyer* - ulrich.meyer@med.uni-duesseldorf.de
* Corresponding author
Abstract
During the last years, implant dentistry has seen an dramatic increase as a treatment option in oral
rehabilitation. This is based to a large extent on scientific advances and clinical improvements in
implantology. The extension of indications has broadened the opprtunities to rehabilitate patients
that were formerly considered to posess restricted indications to place implants. Additionally,
patient desires (high aesthetic demands, fast prosthetic rehabilitation) were placed more in focus,
resulting in new approaches in implant dentistry. As a result, the scientific and clinical community
has reached high standards and at the same time has founded the basis for new opportunities in
implantology. The advances are mirrored by a high number of high quality scientific papers,
published in conventional and open-access journals. A major shift has thereby been observed in the
understanding of implant healing, leading the basis for new implant systems that allow fast
rehabilitation protocols. The term ossseointegration needs a new understanding since an
immediate osseointegration state can be present under distinct conditions.
Osseointegration is commonly defined as a direct and sta-
ble anchorage of an implant by the formation of bony tis-
sue without growth of fibrous tissue at the bone-implant
interface. The term that was initially defined by BRANE-
MARK et al.[1] as a direct bone-to-implant contact was
later on defined on a more functional basis as a direct
bone-to-implant contact under load. A defining morpho-
logical feature of osseointegration is that osteoblasts and
mineralized matrix contacts the implant surface even
when loads are applied. In contrast, failure of osseointe-
gration or a disintegration of a formerly stable anchored
implant can be conceptualized as a failure of the mineral-
ized extracellular matrix directly attached to the artificial
surface, since a mechanically competent implant/bone
implant osseointegration has routinely been utilised, the
specific mechanisms for the emergence and maintenance
of peri-implant bone under functional load was for a long
time not identified in detail. Recent research has now
shown that osseointegration can not be considered in the
traditional sense. Instead of understanding osseointegra-
tion as a predetermined time scale event or an end-state of
implant healing, osseointegration can now be conceptual-
ised as a highly dynamic process of the all time emergence
and maintenance of peri-implant bone. The clinical fate
of implants is not dependant on the implant healing time
but instead it is dependant on multiple parameters, all
influencing the dynamic events that happen in bone. It is
now accepted that both aspects of osseointegration, main-
Published: 30 June 2006
Head & Face Medicine 2006, 2:19 doi:10.1186/1746-160X-2-19
Received: 20 June 2006
Accepted: 30 June 2006
This article is available from: http://www.head-face-med.com/content/2/1/19
© 2006 Joos and Meyer; licensee BioMed Central Ltd.
This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0),
which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.Page 1 of 2
(page number not for citation purposes)
bond is dependent on an intact mineralized interface
structure. Although the bone's capability of dental
tenance of present bone (remodelling) and new bone for-
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Head & Face Medicine 2006, 2:19 http://www.head-face-med.com/content/2/1/19
mation (modelling), determine the fate of implant
healing[2].
The advances in basic scientific and clinical knowledge are
reflected by the high number of high quality papers that
are published in traditional and open access journals. The
'intra-interdisciplinary' thinking of medical practitioners
and scientists is improved when having access to the sci-
entific literature[3]. The extension of knowledge and the
fast alteration of clinical decision making, based to a great
extent on the transformation of basic scientific results into
practical treatment options, can be examplified by recent
alterations in pratical implant dentistry.
The maintenance and emergence was known to be
dependent on the extent of surgical trauma directly at
insertion as well as through load-related deformations
under implant load, especially when immediate or early
loading protocols are applied. The initial mode of
osseointegration critically depends, therefore, to a greater
extent on the geometry of the implant system as well as on
the state of cells and matrix at the surface of the artificially
created implant site. Considering the recent publication
data, it has not yet been convincingly shown on an
ultrastructural level that the surgical procedure, if properly
performed, is accompanied by a disturbance of cell activ-
ity at the surface of the implant bed, nor with a disintegra-
tion of bone minerals. The extent of bone deformation
under load (in the sense of resulting stress and strain dis-
tributions) is perhaps the more important regulating fac-
tor, dependent on the physical properties of the bone
tissue (e-modulus, elasticity, strength), the direction and
amount of the applied forces, and also to a large extent by
the geometry of the implant used. Parallel to the uncer-
tainties concerning details of mineral formation at
implant surfaces, it can be observed in implant literature
that distinct implant types converge on similar screw-type
implant systems. Screw-type implants of parabolic shape
were shown to allow for a high primary congruence
between the host site and the implant surface. Addition-
ally, parabolic-shaped implants seem to impart advan-
tages concerning the load transfer-related micromotion in
the tissues adjacent to the implant surfaces. As such
implants were used successfull under conditions of imme-
diate loading, it must now be recognized that load related
bone reactions at the implant interface may in combina-
tion with substrate effects (under distinct bone quality
and quantity conditions) be responsible for an immediate
osseointegration state. Therfore, it seems to be time to
understand and define the term osseointegration in a new
way.
References
2. Joos U, Wiesmann HP, Szuwart T, Meyer U: Mineralization at the
interface of implants. Int J Oral Maxillofac Surg in press. 2006, May
10
3. Stamm T: Head & Face Medicine – a new journal for ìntra-
interdisciplinary science. Why? When? Where? Head Face
Med 2005, 1:1.yours — you keep the copyright
Submit your manuscript here:
http://www.biomedcentral.com/info/publishing_adv.asp
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(page number not for citation purposes)
1. Branemark PI, Adell R, Breine U, Hansson BO, Lindstrom J, Ohlsson
A: Intra-osseous anchorage of dental prostheses. I. Experi-
mental studies. Scand J Plast Reconstr Surg 1969, 3:81-100.
