Oshida Y. Bioscience and Bioengineering of Titanium Materials

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Chapter 7

Implant-Related Biological Reactions

7.1. Bone Healing 162

7.2. Hemocompatibility 164

7.3. Cell Adhesion, Adsorption, Spreading, and Proliferation 166

7.4. Roughness and Cellular Response to Biomaterials 179

7.5. Cell Growth 182

7.6. Tissue Reaction and Bone Ingrowth 185

7.7. Osseointegration and Bone/Implant Interface 193

7.8. Some Adverse Factors for Loosening Implants 199

References 200

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Chapter 7

Implant-Related Biological Reactions

Dental implants are an ideal option for people in good general oral health who

have lost a tooth (or teeth) due to periodontal disease, an injury, or some other rea-

son. Dental implants (as an artificial tooth root and usually made from titanium

materials) are biocompatible metal anchors surgically positioned in the jawbone

underneath the gums to support an artificial crown where natural teeth are miss-

ing. There are main three different types of dental implants: (i) root form implants,

(ii) plate form implants, and (iii) subperiosteal implants. Using the root form

implants (the closest in shape and size to the natural tooth root), the healing period

usually varies from as few as 3–6 months or more. During this time osseointegra-

tion occurs. The bone grows in and around the implant creating a strong structural

support. Plate (or blade) form implants are usually used when the bone is so nar-

row that it may not be suitable for the root form implant, and the area is not suit-

able for bone grafting. Like root form implants, there is usually a healing period

for osseointegration, although some plate form implants are designed for immedi-

ate restoration (or immediate loading). With very advanced jawbone resorption

there may not be enough bone width or height for the root form or plate form

implant, and the subperiosteal implant may be prescribed. The subperiosteal

implant is custom made and designed to sit on top of the bone, but under the gums.

Generally, any edentulous (toothless) area having enough bone support can be

an indication for restoring a missing tooth with an implant. A decision has to be

made on case-by-case bases whether it is a good idea based on the patient’s

requirements and expectations. Even though there are practically no absolute con-

traindications for placement of implants, there are few factors that can put it in a

high-risk situation. The followings are normally believed as contraindicative fac-

tors: (1) endocrine disorders, such as uncontrolled diabetes mellitus, pituitary and

adrenal insufficiency, and hypothyroidism can cause considerable healing prob-

lems, (2) uncontrolled granulomatous diseases, such as tuberculosis and sarcoido-

sis may also lead to a poor healing response to surgical procedures, (3) patients

with cardiovascular diseases, taking blood-thinning drugs and patients with

uncontrolled hematological disorders, such as generalized anemia, hemophilia

(Factor VIII deficiency), Factors IX, X, and XII deficiencies and any other

acquired coagulation disorders are contraindicated to surgical procedures due to

poor hemorrhage control, (4) patients with bone diseases, such as histiocytosis X,

Paget’s disease and fibrous dysplasia may not be good candidates for implants,

because there is a higher chance for the implant to fail due to poor osseointegration,

159

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