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ePaper created 2016-09-22, 10:58:51 | version 1.38.0
opinion 25th EAO Annual Scientific Meeting 8 Dr Tomas Albrektsson, professor emeritus at the Department of Bio- materials of Gothenburg University in Sweden, started working with Prof. Per-Ingvar Brånemark in 1967 to further develop osseointegrated oral, craniofacial and orthopaedic implants. Since then, Albrektsson has published various papers on the topic of osseointegration and has contributed significantly to the un- derstanding of the underlying biolog- ical mechanism and to the develop- ment of implant dentistry. At this year’s congress of the European As- sociation for Osseointegration (EAO) in Paris, Albrektsson will present the latest insights regarding successful osseointegration and peri-implant marginal bone loss. Today Interna- tional had the opportunity to discuss these topics with him ahead of the event. Today International: Prof. Al- brektsson, more than 50 years ago, Prof. Per-Ingvar Brånemark discovered the process of osse- ointegration,providing the basis for implant dentistry.Since then, the concept has gained accept- ance and much research has been done on osseointegration and the underlying mechanism. What are the latest insights? Prof. Tomas Albrektsson: During the first few decades, os- seointegration was perceived as a natural tissue response to com- mercially pure titanium im- plants. The incorporation of these implants into bone was in- terpretedasasimplewound-heal- ing phenomenon. However, this explanation has been disproved by further research. Today, we view osseointegration as a for- eign-body reaction to protect the body from something potentially harmful, such as titanium or ce- ramic implants. In your research, you emphasise that understanding the biologi- cal basis of osseointegration and the role of bone biology and the immunological aspects is important in order to improve the outcome of implant treat- ment. How far has research come in this field and what is there still to learn? We certainly need more re- search. Having said this, many scientific papers researching the induction of a foreign-body reac- tion in the form of ligatures placed around implants have presented data on the vicious combination of two foreign bod- ies—the implant and the ligature. In clinical research, another such combination of foreign bodies was ob- served, namely when cement parti- cles accidentally enter the soft tissue around the implant. One may say that a successfully placed implant is in a delicate state of balance, described as a foreign-body equilibrium. If another foreign body or certain patient char- acteristics, such as smoking, genetics or the intake of medication, like anti- depressants, are present, the equilib- rium may be disturbed and bone re- sorption may ensue. Moreover, fac- tors such as implant ionic leakage (particle wear), excessive force or bro- ken components may exacerbate the situation and result in osteolytic reac- tions due to immune system activa- tion. The condition of peri-implantitis has been much debated in recent years and there is still no consensus on whether it should be classified as a disease or a complication of placing a foreign body in the oral cavity.What is the main issue in this regard and what is your opinion on the matter? In my opinion, peri-implantitis may be a man-made disease based on an assumed, but false, similarity be- tween teeth and implants. Bone around implants may be lost through an aseptic reaction; macrophages will influence the delicate balance be- tween the bone-forming osteoblasts and the bone-resorbing osteoclasts, in favour of the latter. Osteoblasts and osteoclasts are bone cells, as well as cells belonging to the immune sys- tem. However, problematic implants that lose interfacial bone exist—even if in much smaller numbers than hy- pothesised in the past. Provided that the treating clinicians are well trained and use properly documented implant systems, the actual incidence of implant-compromising marginal bone loss may be in the vicinity of 1–2 per cent of all placed implants if followed up for ten years or longer. Therefore, it is not at all surprising that a recent study reported that more than 95 per cent of the alleg- edly infected implants in another study survived for an average of nine years of follow-up and that more than 90 per cent of the allegedly infected implants displayed no further mar- ginal bone loss, but remained in a sta- ble state with respect to further bone resorption. How can the latest discoveries in bone biology and osseointegration help implantologists in their clinical practice, particularly concerning the treatment of peri-implant bone loss? At present, we do not have an ef- fective means of treating all cases of implant-compromising marginal bone loss. Even if immunological problems, in combination with various adverse factors, account for marginal bone loss, bacteria may exacerbate the sit- uation over time. For this reason, an- tibiotics should be used. We do not know the role bacteria play in this context. Do they only represent a sec- ondary opportunistic colonisation? Do they activate bone-resorbing cells similar to those previously active dur- ing aseptic loosening? Do they, to- gether with biofilms, constitute fur- ther induction of a foreign-body reac- tion, resulting in further bone loss? Moreover, dentists need to be pro- active in seeking to understand why bone is being lost. Could cement par- ticles have caused the problem? Have implant components fractured? Hav- ing said this, previous incorrect alarmist reports have led to overtreat- ment in many cases. Sometimes, it may be sufficient to mainly follow the implants up carefully with frequent patient follow-ups to determine whether the condition will actually worsen or whether a new stable state with respect to no further bone loss will ensue. Prof. Tomas Albrektsson will be pre- senting a paper titled “What is osseo- integration in 2016 and why are we losing bone around dental implants?” on Friday, 30 September, from 13:30 to 15:00., in the Amphithéâtre Bleu at the Palais des Congrès de Paris. “Dentists need to be proactive in seeking to understand why bone is being lost” An interview with EAO speaker Dr Tomas Albrektsson, Sweden “Today, we view osseointegration as a foreign-body reaction to protect the body from something potentially harmful, such as titanium or ceramic implants.” Dental Tribune International ESSENTIAL DENTAL MEDIA www.dental-tribune.com AD