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oral surgery: implant systems

oral surgery

Dear readers,
Last week we introduced the broad topic of oral surgery and of what it takes to face an implant intervention.
Today we examine the implant types in detail, but first we need to define the types of bone adaptation:
1. Bone modeling is the result of a change in shape or size of the bone and can be caused by load response, anabolic alteration (bone apposition), catabolic alteration (bone defect). Note that from 9 to 16 years of age, the elongation of the jaw is the result of bone modeling.
2. Bone remodeling is a change within the bone matrix that occurs during bone wound healing or damage due to load or stress.
In oral surgery, when speaking of bone wounds in implant techniques, there is never a return to the baseline status. In an area of 1 mm around the implant there is always a great cellular activity and an intense remodeling of lamellar bone occurs (with a turnover 500 times superior to an intact bone). This mechanism is called OSSEOINTEGRATION and is what keeps bone implants in place.
The bone adjacent to the implant (1mm) undergoes continuous and fast remodeling, it also appears only mineralized by 70%, thus resembling the periodontal ligament: the lower the rigidity of the implant system, the greater the resistance to micro-trauma.
Note that for women in menopause, except for those who take estrogens, there is a 50% reduction in bone mass.
IMPLANT SYSTEMS in oral surgery
surgical techniques:
monophasic (through the mucosa) and biphasic (submerged).
The basic characteristics of implant fixtures are:

  • design and shape. A complete penetration of the bone does not occur in spaces smaller than 100 mm.
  • Bone/fixture interface. After the period of bone healing (3-6 months) the percentage of integration normally does not exceed 60-70% of the surface of the fixture.

The completion takes place after the application of the prosthetic load which stimulates bone regeneration. The success of an endosseous implant depends on the primary stability (mechanical interlocking between bone and implant) and secondary stability (microscopic interlocking due to the roughness of the titanium’s surface).
After 12 months of healing with no load, the bone structure adherent to the implant surface is mechanically very weak and thin (thickness of 50 microns).
After three months with load, the thickness of the bone structure adherent to the implant surface reaches 150-200 microns.
After 60-80 months of load the bone structure around the implant reaches a thickness of 300-350 microns.

  • fixture/abutment connection. Hydroxyapatite coatings exist: they produce faster osseointegration, but over time cracks may form due to the difficult adhesion of the implant’s coating.

These cracks represent a locus minoris resistentiae for the passage of germs, hence peri-implantitis, which can be a common phenomenon in oral surgery.

We hope that this article has given you useful information and awareness on oral surgery.

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