Biomechanics of Immediate Postextraction Implant Osseointegration

Author:

Yuan X.1ORCID,Pei X.12,Zhao Y.13,Li Z.14,Chen C.H.15,Tulu U.S.1,Liu B.6,Van Brunt L.A.1,Brunski J.B.1,Helms J.A.16ORCID

Affiliation:

1. Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA

2. State Key Laboratory of Oral Diseases, National Clinical Research Center for Oral Diseases, Department of Prosthodontics, West China Hospital of Stomatology, Sichuan University, Chengdu, Mainland China

3. Department of Oral Basic Science, School of Dentistry, Lanzhou University, Lanzhou, Mainland China

4. Department of Orthopedics, Tianjin Medical University General Hospital, Tianjin, Mainland China

5. Craniofacial Research Center, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, Taoyuan, Taiwan

6. Ankasa Regenerative Therapeutics, South San Francisco, CA, USA

Abstract

The aim of this study was to gain insights into the biology and mechanics of immediate postextraction implant osseointegration. To mimic clinical practice, murine first molar extraction was followed by osteotomy site preparation, specifically in the palatal root socket. The osteotomy was positioned such that it removed periodontal ligament (PDL) only on the palatal aspect of the socket, leaving the buccal aspect undisturbed. This strategy created 2 distinct peri-implant environments: on the palatal aspect, the implant was in direct contact with bone, while on the buccal aspect, a PDL-filled gap existed between the implant and bone. Finite element modeling showed high strains on the palatal aspect, where bone was compressed by the implant. Osteocyte death and bone resorption predominated on the palatal aspect, leading to the loss of peri-implant bone. On the buccal aspect, where finite element modeling revealed low strains, there was minimal osteocyte death and robust peri-implant bone formation. Initially, the buccal aspect was filled with PDL remnants, which we found directly provided Wnt-responsive cells that were responsible for new bone formation and osseointegration. On the palatal aspect, which was devoid of PDL and Wnt-responsive cells, adding exogenous liposomal WNT3A created an osteogenic environment for rapid peri-implant bone formation. Thus, we conclude that low strain and high Wnt signaling favor osseointegration of immediate postextraction implants. The PDL harbors Wnt-responsive cells that are inherently osteogenic, and if the PDL tissue is healthy, it is reasonable to preserve this tissue during immediate implant placement.

Funder

National Natural Science Foundation of China

Science & Technology Support Program of Sichuan Province

National Institute of Dental and Craniofacial Research

Publisher

SAGE Publications

Subject

General Dentistry

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