Albrektsson, Acta Orthop Scand 1981 - Osseointegrated Titanium Implants. Requirements for Ensuring a Long-Lasting, Direct Bone-To-Implant Anchorage in Man
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Osseointegrated Titanium Implants. Requirements for Ensuring a Long-Lasting, Direct Bone-To-Implant Anchorage in Man
Albrektsson, Lindström, et al.·Acta Orthop Scand·1981·2,662 citations·Case series
Albrektsson and colleagues examined whether threaded titanium screws placed in human bone without cement achieve and keep direct bone anchorage, and what conditions that requires.
Retrieval analysis of 38 stable, integrated screws removed from 18 patients, drawn from 2895 jaw implants and 124 tibial, temporal or iliac implants, in situ 6 to 90 months.
Methods
Design
Descriptive case series of retrieved implants
Patients
38 removed implants from 18 patients
Drawn from 2895 jaw implants
Drawn from 124 tibial, temporal or iliac implants
Treatment
Unalloyed titanium threaded screws with standardized surface and shape
Inserted without cement
Unloaded healing for at least 3 to 4 months
Follow-up
Implants in situ 6 to 90 months before removal
Outcomes
Radiographs
Scanning electron microscopy (SEM)
Transmission electron microscopy (TEM)
Histology
Key Findings
All 38 retrieved implants were bone‑integrated on radiographs and judged stable by the surgeon at removal.
TEM of one intact interface showed bone touching titanium at the electron‑microscopic level, which the authors said strengthens the possibility of chemical bonding to titanium oxide.
SEM showed bone lying very close to the titanium, with collagen filaments anchored to the metal in a pattern resembling Sharpey's fibres.
No titanium wear products were found, with implantation times ranging from 6 to 90 months.
Soft tissue adhered tightly to implants crossing gingiva or skin, sealing against microorganism infiltration, with no adverse tissue effects.
The authors reported under 10% loss of anchorage at 5 years across their whole clinical experience, drawn from earlier series rather than these retrieved implants.
Board pearl
The authors judged 3 to 4 months of unloaded healing necessary in humans (vs 6 weeks in rabbits) and named immediate loading as perhaps the main cause of a fibrous tissue sheath around implants.
Authors' conclusion
It is concluded that the technique of osseointegration is a reliable type of cement-free bone anchorage for permanent prosthetic tissue substitutes.
Albrektsson and colleagues examined whether threaded titanium screws placed in human bone without cement achieve and keep direct bone anchorage, and what conditions that requires.
Retrieval analysis of 38 stable, integrated screws removed from 18 patients, drawn from 2895 jaw implants and 124 tibial, temporal or iliac implants, in situ 6 to 90 months.
Methods
Design
Descriptive case series of retrieved implants
Patients
38 removed implants from 18 patients
Drawn from 2895 jaw implants
Drawn from 124 tibial, temporal or iliac implants
Treatment
Unalloyed titanium threaded screws with standardized surface and shape
Inserted without cement
Unloaded healing for at least 3 to 4 months
Follow-up
Implants in situ 6 to 90 months before removal
Outcomes
Radiographs
Scanning electron microscopy (SEM)
Transmission electron microscopy (TEM)
Histology
Key Findings
All 38 retrieved implants were bone‑integrated on radiographs and judged stable by the surgeon at removal.
TEM of one intact interface showed bone touching titanium at the electron‑microscopic level, which the authors said strengthens the possibility of chemical bonding to titanium oxide.
SEM showed bone lying very close to the titanium, with collagen filaments anchored to the metal in a pattern resembling Sharpey's fibres.
No titanium wear products were found, with implantation times ranging from 6 to 90 months.
Soft tissue adhered tightly to implants crossing gingiva or skin, sealing against microorganism infiltration, with no adverse tissue effects.
The authors reported under 10% loss of anchorage at 5 years across their whole clinical experience, drawn from earlier series rather than these retrieved implants.
Board pearl
The authors judged 3 to 4 months of unloaded healing necessary in humans (vs 6 weeks in rabbits) and named immediate loading as perhaps the main cause of a fibrous tissue sheath around implants.
Authors' conclusion
It is concluded that the technique of osseointegration is a reliable type of cement-free bone anchorage for permanent prosthetic tissue substitutes.