Stages of Healing in Dental Implants
Besides the clinical skills of the Dentist, the success of implants also depends on interaction of Mechanical and Patient Metabolic factors. Metabolic factors such as diabetes, immune compromised diseases, osteoporosis, history of radiation etc. interfere in healing and healing time of bone around the dental implants. Calcium metabolism (Thyroid, Parathyroid, Vitamin D etc) predominates the quality of bone formed. Local factors such as poor oral hygiene and smoking also affect the Bone quality and quantity. The decision of your Dentist regarding timeline, and functionality of Dental Implants is primarily regulated by the clinical correlation of Metabolic, Mechanical Factors and healing of bone around Dental Implants.
The process of Osseo-integration (union of implant with bone) is complex and usually takes few weeks or months after the Dental Implant surgery. This bio-dynamic process of bone repair and regeneration around the implants, which determines the functional readiness of Dental Implant is explained in detail as below:-
Stage -1 Haemostasis and Inflammation
Within Few Hours:
Your Dentist has placed the Dental Implants. Before leaving the dental office, compression of the wound and placement of sutures was done by your Dentist to accelerate optimal healing and achieve Hemostasis (cessation of bleeding). The dental office staff will give you a set of Instructions after Dental Implants Surgery to follow. Please follow them carefully.
During the Implant site preparation, Drills are used to prepare the surgical bed for Dental Implant. Often the Micro Blood Vessels and small bony fragments in the bone are sectioned and separated during the drilling process, which begins cell-to-cell interactions. The blood from the micro blood vessels activates the clotting mechanism. The platelets start aggregating around the cross linking collagen fibers forming a matrix and coagulum is formed between the implant surface and bone, which stabilises the Hemostasis (cessation of bleeding).
Within 6 hours of the blood clot stabilization, the most abundant circulating immune cells, representing the first defense line of your immune system (Polymorphonuclear neutrophils, PMN) gets activated and starts reaching the site.
Day 1-2:
The number of Polymorphonuclear neutrophils (PMN) increases steadily, peaking at about 24-48 hours of Dental Implants Surgery and the Inflammation begins. The Polymorphonuclear neutrophils (PMN) or the immunity cells start cleaning up surgical site-removing debris, possible bacteria, sectioned small bony residues.
Day 3-4:
As the number of Polymorphonuclear neutrophils (PMN's) begins to drop after the third day, the more bioactive immune cells, representing the second defense line - Macrophages reach peak concentration. As they are more bioactive, they secrete vast array of cytokines- leading to initiation of healing. The macrophages play a major role in decontamination and removal of residual bony residues. They play a major role in activation of T Lymphocytes and regulation of healing of bone around Dental Implants. This marks the reduction of Inflammation.
Stage -2 Proliferative Phase
Day 5-7:
The gum cells (epithelial cells) become highly active during this phase and achieves Initial Closure. Between the Dental Implant and the bone, a new fragile matrix of fibrin, new blood vessels is laid. A mesh of collagen fibres starts becoming organised by cross linking. The fibroblasts cells align themselves parallel to the wound surface. New Blood vessels at the site of injury takes place by proliferation of endothelial cells from margins of severed blood vessels.
Stage -3 Soft Callus Formation
Day 8-21:
From 8th to 10th day of the dental implant surgery, a thick mass of callus starts appearing between the bone and the Implant surface. This mass of callus is a highly cellular osseous tissue (also known as Woven Bone) and grows at a rate of 30 to 50 Microns per day. Around 15th day, this soft callus grows under the implant and at the crest of the top threads of the implant. Soft callus is plastic and can easily deform or bend. This soft callus or woven bone has a very low mineral content, random fiber orientation and minimal strength, however it serves an important purpose of stabilizing the implants. Although it is capable of stabilizing the unloaded implants, woven bone lacks the strength to resist functional loads. It is this Soft callus, which gets organised and remodelled into hard callus over several weeks until there is no interfragmentary movement of the Soft Callus.
Fibrous Union
Hard callus is weaker than normal bone but is better able to withstand external forces and equates to the stage of "clinical union", i.e. the fracture is not tender to palpation or with movement.
Stage -4 Hard Callus Formation
Day 22-64 (9 weeks/2 Months):
At about 3rd week, small crystals of hydroxyapatite start getting densely packed in an ordered array according to the collagen fibre orientation. This process is called mineralization or Hardening of the woven bone. Depending on environmental conditions, bone forms as a remarkably ordered biomaterial at both molecular and macroscopic level.
Lamellar Compaction
A woven bone callus fills with lamellae by the process of lamellar compaction. Lattice of woven bone is sufficiently compacted. The rate of formation of lamella is relatively slow ie less than 1 micron per day. The callus matures, densely mineralized and achieves sufficient strength.
Stage Interface Remodelling
Callus starts to resorb along with lamellar compaction and Interface Re-modeling begin at the same time and are complete by 18 weeks. (4 Months). Interface remodeling is essential in establishing a viable interface between implant and the original bone.
The cortical bone thickness was thicker in the lingual side than the labial side both on the maxilla and mandible except for L1, L2 around the alveolar crest. In particular, the labial cortical bone thickness in the maxilla was thinnest compared to the other regions. In addition, the cancellous bone thickness in the maxilla increased to the root apex, and it was thinnest at the middle level of the root in the mandible. For implant placement on the anterior region, a careful evaluation and full knowledge on the thickness of cortical and cancellous bone are necessary, providing an anatomic guideline to clinicians.
Lamellar bone is the principle load-bearing tissue adult skeleton. It is the predominant component of mature cortical and trabecular bone. In adults are found relatively slow have highly organised Matrix and dense mineralised bone lamellar bone is histologically similar regardless of age at which it is formed.
(2-6 weeks)
About a millimetre of compact adjacent to the oceans moon dies postoperatively despite optimal surgical technique this is probably because of inflammation and relatively poor Collateral circulation within the cortical bone. Dead bone is not useless tissue it provides important structural support during initial healing phase however it must be replaced with the vital bone to strengthen the interface provide adaptable tissue for long-term maintenance.
Stage -5 Maturation (6-18 weeks)
Day 65-190 (27 weeks/6 Months):
Maturation of the bone surrounding implant begins after an elapsed time of 8-12 months from the date of implant placement. Bone Maturation phase lasts for about 8 months. In general re-modeling sites are more prevalent towards the bone-implant interface. It is also well accepted that stiffness and strength of lamellar bone are directly related to the mineral contact. Because of this it was previously suggested that the full strength of the bone surrounding the implant would not be achieved until about 8 to 12 months.
Structure of Bone
Bone is highly ordered composite of organic Matrix and inorganic mineral. What is matrix referred to as osteoid before mineralization is primarily collagen fibres embedded in ground substance. The latter is a viscous gel of water and glycoprotein complexes. Ground substances also contains numerous organic factors (cytokines, growth factors) that help control cell activation Matrix maturation and mineralization. During mineralization small crystals of hydroxyapatite a densely packed in an ordered array according to the collagen fibre orientation. Depending on environmental conditions, bone forms as a remarkably ordered biomaterial had both molecular and macroscopic level.
Classification
· Woven bone
· Composite bone
· Lamellar bone
Lamellar bone is the principle load-bearing tissue adult skeleton. It is the predominant component of mature cortical and trabecular bone. In adults are found relatively slow have highly organised Matrix and dense mineralised bone lamellar bone is histologically similar regardless of age at which it is formed.
Composite bone is lamellar bone deposited on a woven bone matrix. During Rapid growth and bone healing highly porous woven bone latest gross out and captures the blood vessels along industrial or periosteal surface the woven latest them feel the perivascular spaces with high quality laminate resulting in composite bone with adequate strength for load bearing. Depending on the rate at which the letters forms the finished product is variation of fine cancellous compaction fore course cancellous compaction lamellar compaction of composite bone is an important step in achieving stabilization of implant during rigid integration process.
Lamellar Bone
Trabacular Bone
Cortical Bone
Avoid Immediate Crowns Help Bone around implant Heal?
Has the bone healed in the first week after the implant? Your Dentist has used the best Dental Implant in the market and claims Immediate functioning, Does the healing differ with different types of implants? The answer is No. The truth is that healing of the bone around Dental implant does not even recognise any different brands and types of Implants and irrespectively adopts the course. Threads of the implant during the first week only hold the bone mechanically while it heals. However in the event of placement of crowns immediately, the risk for implant failure multiplies. The best and scientific proven practise is to allow the bone sufficient opportunity to heal. Don’t Rush.What affects healing in 1st week?
Related Articles
Healthy Diet After Dental Implants Surgery
Medically Reviewed by Dr Rosy Dhawan, MDS For success of the Dental Implant Surgery, your jaw bone needs to build around it and form a bony union. A healthy, well-balanced diet and rich in key nutrients can help speed up the healing of bone around ...Instructions after Dental Implants Surgery
Please follow these instructions as closely as possible. They are designed to help you heal quickly, and comfortably, with minimal side effects. If you-experience any complications, please call our office. FOR THE REMAINDER OF THE DAY: Restrict you ...Diet Chart after Dental Implant Placement
Medically Reviewed by Dr Rosy Dhawan, MDS For success of the Dental Implant Surgery, your jaw bone needs to build around it and form a bony union. A healthy, well-balanced diet, rich in key nutrients can help speed up the healing process of bone ...What to Expect in Dental Impressions?
Dental impressions are very common and used for many dental purposes. The impressions of the teeth and the mouth to form shapes and the formation of objects through it are the dental impressions. It creates a close replica of your set of teeth and ...Importance of Occlusal Adjustment Visit
Have you been bothered by moderate to severe pain under a recently crowned tooth by the Dentist? Is the pain under the new dental crown or restoration noticeable when biting down on something ordinary like a piece of cake? There might be several ...