Can Osseointegration Be Achieved Without Primary Stability?

Al‐Sabbagh, Mohanad; Eldomiaty, Walied; Khabbaz, Yasser

doi:10.1016/j.cden.2019.02.001

Cited by 46 publications

(41 citation statements)

References 40 publications

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“…Notably, although sufficient primary stability is required for immediate loading protocols, it is not a pre-requisite for the implant osseointegration, as was demonstrated by implants that were submerged or properly stabilized, that were able to osseointegrate in cases with low primary stability [56].…”

Section: Discussionmentioning

confidence: 99%

Under-Drilling versus Hybrid Osseodensification Technique: Differences in Implant Primary Stability and Bone Density of the Implant Bed Walls

et al. 2020

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The goal of this study was to evaluate the effects of two implant bed preparation techniques on the implant primary stability (IPS) and the bone density of the implant site. We completed 40 implant bed osteotomies in pig ribs using two techniques: osseodensification (OD) plus under-drilling (UD) with universal osseodensification drills (Test A), and under-drilling alone with drills of the same implant system (Test B). Implants with a 4.1 mm diameter and 10 mm length were inserted, and the IPS was evaluated with three methods: (insertion torque (IT), periotest (PTV), and resonance frequency analysis (RFA). The bone density was evaluated using micro-computed tomography. ANOVA and Tukey’s post-hoc test were used for comparison of the IPS values, and Kruskal–Wallis was used to evaluate the bone density. Statistical significance was set at p < 0.05. The tested B technique (UD) achieved a higher IPS compared to the Test A technique (OD + UD) for all the evaluation methods (p < 0.05). Bone density was higher at the apical and middle region in Test A compared to Test B and control sites (p < 0.05). We concluded that although the bone density increased with the hybrid OD technique with universal drills, implant beds prepared with UD using drills with geometry similar to that of the implant are more efficient at increasing IPS values.

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Section: Discussionmentioning

confidence: 99%

Under-Drilling versus Hybrid Osseodensification Technique: Differences in Implant Primary Stability and Bone Density of the Implant Bed Walls

et al. 2020

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“…To overcome these complications, the chemical and mechanical characteristics of these devices are being tuned accordingly. For example, several coatings have been exploited to reduce the biofilm formation [18][19][20] and increase the life expectancy of the implants [21][22][23], while tailorable mechanical responses can improve the formation of an optimal interaction with the physiological tissue [24][25][26], reducing the stress-shielding effect at the interface that is responsible for most of the failures of these devices. Among these perspectives, the surface composition and morphology are crucial parameters that influence the primary response of the body to an implant depending on the anatomical region [27].…”

Section: Introductionmentioning

confidence: 99%

Selective Laser Melting and Electron Beam Melting of Ti6Al4V for Orthopedic Applications: A Comparative Study on the Applied Building Direction

et al. 2020

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The 3D printing process offers several advantages to the medical industry by producing complex and bespoke devices that accurately reproduce customized patient geometries. Despite the recent developments that strongly enhanced the dominance of additive manufacturing (AM) techniques over conventional methods, processes need to be continually optimized and controlled to obtain implants that can fulfill all the requirements of the surgical procedure and the anatomical district of interest. The best outcomes of an implant derive from optimal compromise and balance between a good interaction with the surrounding tissue through cell attachment and reduced inflammatory response mainly caused by a weak interface with the native tissue or bacteria colonization of the implant surface. For these reasons, the chemical, morphological, and mechanical properties of a device need to be designed in order to assure the best performances considering the in vivo environment components. In particular, complex 3D geometries can be produced with high dimensional accuracy but inadequate surface properties due to the layer manufacturing process that always entails the use of post-processing techniques to improve the surface quality, increasing the lead times of the whole process despite the reduction of the supply chain. The goal of this work was to provide a comparison between Ti6Al4V samples fabricated by selective laser melting (SLM) and electron beam melting (EBM) with different building directions in relation to the building plate. The results highlighted the influence of the process technique on osteoblast attachment and mineralization compared with the building orientation that showed a limited effect in promoting a proper osseointegration over a long-term period.

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“…Placement of the implant in the bone should result in immediately inadequate primary stability, but the degree of primary stability is influenced by several factors, such as surgical technique, design of the implant, the texture of the implant's surface, loading, micromotion, and quality of surrounding bone (143)(144)(145)(146). Primary stability also has been defined as "mechanical stability, " because it occurs immediately after implant placement and it is not affected by osseointegration (147,148). Primary stability can be easily evaluated under in-vivo as well as ex-vivo conditions because it is associated only with mechanical properties.…”

Section: Stability Of the Implant In Bonementioning

confidence: 99%

“…Secondary stability increases as new bone is formed around and especially in contact with the implant (Figure 1) (10). Secondary stability is required for the long-term stability of the interface between the implant and bone and it is brought about by the process of osseointegration (147,153). Secondary stability has been termed "biological stability" (147).…”

Section: Stability Of the Implant In Bonementioning

confidence: 99%

“…Secondary stability is required for the long-term stability of the interface between the implant and bone and it is brought about by the process of osseointegration (147,153). Secondary stability has been termed "biological stability" (147). The same factors impacting osseointegration equally affect secondary stability as both processes are interdependent and occur simultaneously (4,(23)(24)(25)(26)(27)(28)(29).…”

Section: Stability Of the Implant In Bonementioning

confidence: 99%

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Bone and Cartilage Interfaces With Orthopedic Implants: A Literature Review

et al. 2020

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The interface between a surgical implant and tissue consists of a complex and dynamic environment characterized by mechanical and biological interactions between the implant and surrounding tissue. The implantation process leads to injury which needs to heal over time and the rapidity of this process as well as the property of restored tissue impact directly the strength of the interface. Bleeding is the first and most relevant step of the healing process because blood provides growth factors and cellular material necessary for tissue repair. Integration of the implants placed in poorly vascularized tissue such as articular cartilage is, therefore, more challenging than compared with the implants placed in well-vascularized tissues such as bone. Bleeding is followed by the establishment of a provisional matrix that is gradually transformed into the native tissue. The ultimate goal of implantation is to obtain a complete integration between the implant and tissue resulting in long-term stability. The stability of the implant has been defined as primary (mechanical) and secondary (biological integration) stability. Successful integration of an implant within the tissue depends on both stabilities and is vital for short- and long-term surgical outcomes. Advances in research aim to improve implant integration resulting in enhanced implant and tissue interface. Numerous methods have been employed to improve the process of modifying both stability types. This review provides a comprehensive discussion of current knowledge regarding implant-tissue interfaces within bone and cartilage as well as novel approaches to strengthen the implant-tissue interface. Furthermore, it gives an insight into the current state-of-art biomechanical testing of the stability of the implants. Current knowledge reveals that the design of the implants closely mimicking the native structure is more likely to become well integrated. The literature provides however several other techniques such as coating with a bioactive compound that will stimulate the integration and successful outcome for the patient.

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Can Osseointegration Be Achieved Without Primary Stability?

Cited by 46 publications

References 40 publications

Under-Drilling versus Hybrid Osseodensification Technique: Differences in Implant Primary Stability and Bone Density of the Implant Bed Walls

Under-Drilling versus Hybrid Osseodensification Technique: Differences in Implant Primary Stability and Bone Density of the Implant Bed Walls

Selective Laser Melting and Electron Beam Melting of Ti6Al4V for Orthopedic Applications: A Comparative Study on the Applied Building Direction

Bone and Cartilage Interfaces With Orthopedic Implants: A Literature Review

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