New paradigm in implant osseointegration

Osseointegration is commonly defined as a direct and stable anchorage of an implant by the formation of bony tissue without growth of fibrous tissue at the bone-implant interface. The term that was initially defined by BRANEMARK et al.[1] as a direct bone-to-implant contact was later on defined on a more functional basis as a direct bone-to-implant contact under load. A defining morphological feature of osseointegration is that osteoblasts and mineralized matrix contacts the implant surface even when loads are applied. In contrast, failure of osseointegration or a disintegration of a formerly stable anchored implant can be conceptualized as a failure of the mineralized extracellular matrix directly attached to the artificial surface, since a mechanically competent implant/bone bond is dependent on an intact mineralized interface structure. Although the bone's capability of dental implant osseointegration has routinely been utilised, the specific mechanisms for the emergence and maintenance of peri-implant bone under functional load was for a long time not identified in detail. Recent research has now shown that osseointegration can not be considered in the traditional sense. Instead of understanding osseointegration as a predetermined time scale event or an end-state of implant healing, osseointegration can now be conceptualised as a highly dynamic process of the all time emergence and maintenance of peri-implant bone. The clinical fate of implants is not dependant on the implant healing time but instead it is dependant on multiple parameters, all influencing the dynamic events that happen in bone. It is now accepted that both aspects of osseointegration, maintenance of present bone (remodelling) and new bone formation (modelling), determine the fate of implant healing[2].The advances in basic scientific and clinical knowledge are reflected by the high number of high quality papers that are published in traditional and open access journals. The 'intra-interdisciplin