Osseointegration derives from ‘osteon,’
the Greek word for bone and the Latin
word for ‘to make whole’ which is
This refers to the process that will take
place between the living bone and the
surface of implant.
The concept of
developed and the term
was coined by Dr. Per-
Professor at the institute
of Goteborg, Sweden .
HISTORY OF BRANEMARK
EARLY STAGE (1965-1968)
DEVELOPMENTAL STAGE (1968-
PRODUCTION STAGE (1971 –
Structurally oriented definition “Direct structural
and functional connection between the
ordered, living bone and the surface of load
carrying implants”. - Branemark and associates
“The apparent direct attachment or connection
of osseous tissue to an inert, alloplastic material
without intervening connective tissue”. - GPT 8
“It is a process where by clinically asymptomatic rigid
fixation of alloplastic material is achieved and
maintained in bone during functional loading” - Zarb
and T Albrektsson (1986)
Biomechanically oriented definition
“Attachment resistant to shear as well
as tensile forces” - Steinmann et al
BONE TO IMPLANT
TWO BASIC THEORIES :
OSSEOINTEGRATION (BRANEMARK 1985)
(LINKOW 1976 JAMES 1975 WEISS 1986)
BONE TO IMPLANT
• Meffert et al (1987)
In 1986,the American Academy of Implant Dentistry(AAID) defined
“Tissue to implant contact with interposition healthy dense collagenous tissue
between the implant and bone’’
Presence of connective tissue between the
implant and bone .
Collagen fibers functions similarly to Sharpey’s
fibers found in natural dentition.
The fibers are arranged irregularly, parallel to
the implant body, when forces are applied they
are not transmitted through the fibers.
“Pseudoligament”, “Periimplant ligament”, “Periimplant
FAILURE OF FIBRO-OSSEOUS
• No real evidence
• Forces are not transmitted through the fibers
- remodeling was not expected .
• Forces applied resulted in widening fibrous
encapsulation, inflammatory reactions, and
gradual bone resorption there by leading to
• Healing process may be primary bone healing
or secondary bone healing.
• In primary bone healing, there is well organized
bone formation with minimal granulation tissue
formation - ideal
• Secondary bone healing may have granulation
tissue formation and infection at the site,
prolonging healing period. (Fibrocartilage is
sometimes formed instead of bone –
BIOLOGICAL PROCESS OF
• According to Misch,
there are two stages in osseointegration,
• Each stage been again divided into two
• Woven callus
Woven bone is formed at implant site.
• Primitive type of bone tissue and
characterized Random, felt-like orientation
of collagen fibrils
• Numerous irregularly shaped osteocytes
• Relatively low mineral density
• Lamellar compaction
• The woven callus matures as it is replaced
by lamellar bone.
• This stage helps in achieving sufficient
strength for loading.
• Interface remodeling
• This stage begins at the same time when
woven callus is completing lamellar
• During this stage callus starts to resorb,
and remodeling of devitalized interface
• The interface remodeling helps in
establishing a viable interface between the
implant and original bone.
• Compact bone maturation
• During this stage compact bone matures
by series of modeling and remodeling
• The callus volume is decreased and
interface remodeling continues.
BONE TISSUE RESPONSE
Osborn and Newesley (1980) : Proposed 2 different phenomena
Distance Osteogenesis :
A gradual process of bone healing inward from
the edge of the osteotomy toward the implant.
Bone does not grow directly on the implant
• The direct migration of bone-building cells
through the clot matrix to the implant surface.
• Bone is quickly formed directly on the implant
FACTORS THAT INFLUENCE
Revised Albrektsson Success
Int J Oral Maxillofac Implants. 1986 Summer;1(1):11-
The long-term efficacy of currently used dental
implants: a review and proposed criteria of success.
Albrektsson T, Zarb G, Worthington P, Eriksson AR.
Osseoperception is defined as mechanoreception in the absence of a
functional periodontal mechanoreceptive input but derived from
temporomandibular joint (TMJ)
• The “osseointegration” is a multifactorial entity.
• Achieving the osseointegration of the endosteal
dental implants needs understanding of the many
•Thorough understanding and application of factors
affecting the osseointegration and biological
process of osseointegration in clinical practice is the
key factor for success.
– Hobo, Ichida, Garcia “Osseointegration and
occlusal rehabilitation” Quintessence Publishing.
– Jan Lindhe “Clinical periodontology and implant
dentistry” 4th edition, Blackwell Publishing.
– Elaine McClarence “Branemark and the
development of osseointegration” Quintessence
– Carl E. Misch “Implant dentistry” 2nd edition,
– Charles M.Weis “Principles and practice of
implant dentistry” Mosby.
– Per Ingvar Branemark “Osseointegration and its
experimental background” JPD 1983 Vol. 50, 399-
– Hanson, Alberktson “Structural aspects of the
interface between tissue and titanium implants”
JPD 1983 vol. 50, 108-113.
– T. Alberktson “Osseointegrated dental implants”
DCNA Vol. 30, Jan 1986, 151-189.
– Richard Palmer “Introduction to dental implants” BDJ,
Vol. 187, 1999, 127-132.
– Geroge A. Zarb “Osseointegrated dental implants:
Preliminary report on a replication study”. JPD 1983,
Vol 50, 271-276.
– Bergman “Evaluation of the results of treatment with
osseointegrated implants by the Swedish National
Board of Health and Welfare”. JPD 1983, vol. 50, 114-