- 1. A bioengineered implant for a predetermined bone cellular
response to loading forces.A literature review and case report.
Misch CE. Bidez MW, Sharawy M J Periodontol 2001;72:1276-1286
2. 3.
- Bone , systemic change, local mechanical factors.
- Wolff 1982 bone adaptive properties mechanic stimuli :
-
- ( ) bone volume remaining bone
- Cortical, trabecular bone modeling, remodeling
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- Modeling formation resorption bone
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- Remodeling formation resorption previous bone bone quality
- Bone modeling and remodeling strain mechanical environment
4.
- bone type osseointegrated implant
-
- Lamellar bone bone type most organized, highly mineralized,
strongest load bearing bone
-
- Woven bone bone type unorganized, less mineralized, less
strength immature bone
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- Composite bone lamellar, woven bone cortical bone endosteal,
periosteal surfaces
5. 6.
- Cortical bone fractures 10,000 20,000 microstrain (1~2%
deformation) bone
- Microstrain levels remodeling rate
-
- bone cell membrane mechanosensory system
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- bone cellular behavior bone cells strain deformation mechanical
environment
- microstrain bone cell membrane ion membrane channel load
7. Frost 1989 (strain) 4 microstrain zone
- pathologic overload zone acute disuse window bone volume
-
- Pathologic overload microfracture repair net bone
resorption
-
- Disuse zone remodeling bone mass
-
- Mild overload zone higher bone turnover rates more woven
bone
-
- Adapted window organized, mineralized lamellar bone
8.
- Remodeling rate(bone turnover) (new bone) existing bone
bone
-
- Bone remodeling rate (BRR) (volume) (percentage)
-
- woven bone 60microns ( 10 -6 m) Lamellar bone 1~5microns
- create maintain mechanical challenge bone mass adaptive window
zone more reactive woven bone Mild overload zone higher BRR
9.
- Adapted window zone organized, highly mineralized lamellar
bone
-
- adapted window dental implant bone more mature periodic changes
more resistant
-
- adaptive window zone Implant-bone interface adjacent to away
from implant BRR
- BRR implant interface strength Implant-bone interface risk
degree
- Higher risk higher turnover rates bone interface less
mineralized, less organized, weaker
10. Implant interface remodeling 11.
- implant Interface remodeling dental implant original bone bone
interface
-
- healing implant interface bone 4 mature vital bone osteoblasts
deposit 70% mineral
-
- 30 mineral deposition 8 secondary mineralization
-
- Bone mineralization bone implant interface
- implant load interface remodeling
-
- Implant long-term maintenance interface continuous
remodeling
- new bone sustained microfractures fatigue bone cyclic
loading
- Frost 1960 microdamage elevated remodeling activity
12.
- rib long bone shaft diaphysis cortical bone 2~10% remodel
(Parfitt 1983 )
- jaw bone BRR rib long bone shaft diaphysis cortical bone 40
(Tricker 1977 )
- Verborgt 2000 (ulna) fatigue loading microcracks TUNEL-positive
osteocytes
-
- Intracortical resorption 300
-
- microdamage osteocyte apoptosis subsequent bone remodeling
- Screw-type implant cortical bone microdamage insertion pullout
forces microdamage implant thread design
13. bioengineering of an implant design
- implant design bioengineering loading adapted window zone
microstrain loading interface lamellar bone implant interface
BRR
- implant interface strain implant lamellar bone remodeling
rate
14.
-
- anatomical dimension limitation, macrodesign criteria
- Engineering strain-controlled bone turnover.
15.
- shear loading square thread design axial loading body
-
- microstrain square thread 4 thread pitch
16.
- 1994 University of Alabama at Birmingham(UAB) research team
load bioengineered implant .
- UAB BioHorizons implant system Maestro implants
Lekholm,Zerb,Misch
- 1995 bioengineering thread design.
17. 18.
- 1996 June, symphysis donor graft alloplast allograft sinus
graft.
- 1997 January 4 bioengineered implants(Maestro, BioHorizons
implant system) 3 bioengineered implants ( 4mm; 11~13mm)
19. 20.
21.
-
- BRR 2 bone labels (tetracycline 500mg)
22.
- woven bone remodeling rate
23. 24.
- Frost 1983 bone repair modeling remodeling trauma( ) regional
acceleratory phenomenon(RAP)
- unloaded control implants
25.
-
- loading occlusal overload rigid fixation
-
-
- 8 screw-shaped implants 4 8 supra-occlusal contacts 10
-
-
- 5/8 with supra-occlusal loads mobile
-
-
- rigid fixation failure fatigue microfracture repair
potential
- Rangert 1995 prosthetic load implant component implant body
fracture.
- crestal bone loss excessive load overload .(Hoshaw 1994 ,Misch
1995 ,Quirynen 1992 )
26.
- Excessive stress microfracture microstrain interface pathologic
mild overload zone
- Microstrain environment prosthodontic loading turnover
rate
- Overload zones(Frost 1989 ) lamellar bone woven bone reactive
woven bone weaker more flexible biomechanical mismatch.(Misch 1999
)
-
- biomechanical mismatch strain
- rigid fixation interface bone prosthodontic load
microdamage
27. 28.
- functionary unit elevated BRR (Garetto 1995 )
- BRR implant body design surface condition
-
- Cooper 1991 ( ) Roberts 1997 macrosphere surface(Endopore,
Innova) elevated turnover rate
-
- smooth collar designs crestal bone loss disuse atrophy overload
(Vaillancourt 1995 )
-
- more stress crestal regions Cooper greater strain condition
BRR
29.
- Roberts 1997 asymmetric implant thread design(Steri-Oss, Nobel
Biocare) symmetrical threaded surface(Branemark, Nobel
Biocare)
-
- (Steri-Oss, Nobel Biocare) reverse buttress thread
shape(680%BRR) symmetrical threaded surface(Br nemark, Nobel
Biocare) V-shaped thread higher bone contact reduced bone turnover
rate(500%).
30.
- Barbier 1997 implant-supported prostheses non-axial load axial
load
-
- axially loaded implants non-axially loaded implant greater
BRR
- Non-axial loads axial loads stress (Misch 1994 )
-
- higher cellular response( osteoblasts inflammatory cells) under
non-axial shear loading condition
31.
- Burr 1993 tibial metaphyseal bone HA/TCP-coated uncoated
titanium implants cylinder implants remodeling activity
-
- titanium surface implants greater bone turnover rates
-
- Cook 1987 Thomas 1987 HA coatings greater interface strength
greater bone mineralization remodeling rate
- HA-coated implants functional loading 9~10 morphological
changes(Baltag 2000 )
- Hoshaw 1992 titanium-threaded implants axial tensile loading
higher remodeling rates less mineralized bone( loading )
32.
- Baumgarder 2000 bone quality-based implant system
-
- 6 8 implants quantitative histomorphometric analysis 53.7 4.2
bone contact
-
- woven bone formation, threads mature formed osteons
-
- threads mm bone turnover rate
-
- Loading 6 2 remodeling cycle lamellae compaction
-
- vertical chewer, bruxism clenching
33.
-
- Bone-implant 30 remodeling
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- 40 remodeling adapted window zone