Biomaterial and biomechanical considerations to prevent risks in implant therapy

Abstract

This paper is aimed to present a biomaterials perspective in implant therapy that fosters improved bone response and long‐term biomechanical competence from surgical instrumentation to final prosthetic rehabilitation. Strategies to develop implant surface texturing will be presented and their role as an ad hoc treatment discussed in light of the interplay between surgical instrumentation and implant macrogeometric configuration. Evidence from human retrieved implants in service for several years and from in vivo studies will be used to show how the interplay between surgical instrumentation and implant macrogeometry design affect osseointegration healing pathways, and bone morphologic and long‐term mechanical properties. Also, the planning of implant‐supported prosthetic rehabilitations targeted at long‐term performance will be appraised from a standpoint where personal preferences (eg, cementing or screwing a prosthesis) can very often fail to deliver the best patient care. Lastly, the acknowledgement that every rehabilitation will have its strength degraded over time once in function will be highlighted, since the potential occurrence of even minor failures is rarely presented to patients prior to treatment.

Osseodensification effect on implants primary and secondary stability: Multicenter controlled clinical trial

“…The interfacial stress distribution and the respective peri‐implant tissue strain due to frictional forces resulting from the interplay between osteotomy and macrogeometry, during implant placement, have shown to control the mechanical interlocking necessary for increased primary stability, as well as enhanced bone healing response 8–11 . Bone tissue tolerates certain levels of compressive strain, even beyond the yield point without affecting the osseointegration progression, which through the elastic behavior improves the physical engagement at the bone‐implant interface, resulting in higher IT and ISQ values 34 .…”

“…Given bone elastic properties, the interfacial stress distribution during implant installation and the respective peri‐implant tissue strain due to frictional forces, present a linear relationship. Thus, bone density in the peri‐implant vicinity along with implant macrogeometry and its related surgical instrumentation have been assumed as key morphometric predictors of IT, as well as healing kinetics 7–11 . A robust body of research has investigated the interplay between such factors, where the mismatch between the implant and instrumented bone walls dictates the course of osseointegration around the metallic device through a predominantly interfacial bone remodeling, predominantly intramembranous‐like healing or hybrid healing pathways, which affects the rate at which secondary stability occurs 8–12 .…”

“…Certain adjustments in the osteotomy preparation protocols have recently been proposed to achieve atemporally stable devices. These include osseodensification (OD) drilling 8–11,13,14 …”

Failure Modes and Survival of Anterior Crowns Supported by Narrow Implant Systems

“…The interplay between implant macrogeometry and surgical instrumentation, bone availability, and quality have a profound influence on the achievement of optimal primary stability, favoring an undisturbed peri-implant healing, which can render the system a temporal load-bearing capability [ 19 – 23 ]. The characteristics of the implant design, especially the body and apex shape and thread profile, regulate bone response during implant placement, controlling the stress distribution to the surrounding bone and implant stabilization [ 23 – 26 ].…”

“…The characteristics of the implant design, especially the body and apex shape and thread profile, regulate bone response during implant placement, controlling the stress distribution to the surrounding bone and implant stabilization [ 23 – 26 ]. Therefore, implant geometry has significantly evolved over the years to maximize the biomechanical performance, especially in compromised bone scenarios [ 19 – 21 ].…”