title: Multiscale analyses of the bone-implant interface.
abstract: Implants placed with high insertion torque (IT) typically exhibit primary stability, which enables early loading. Whether high IT has a negative impact on peri-implant bone health, however, remains to be determined. The purpose of this study was to ascertain how peri-implant bone responds to strains and stresses created when implants are placed with low and high IT. Titanium micro-implants were inserted into murine femurs with low and high IT using torque values that were scaled to approximate those used to place clinically sized implants. Torque created in peri-implant tissues a distribution and magnitude of strains, which were calculated through finite element modeling. Stiffness tests quantified primary and secondary implant stability. At multiple time points, molecular, cellular, and histomorphometric analyses were performed to quantitatively determine the effect of high and low strains on apoptosis, mineralization, resorption, and collagen matrix deposition in peri-implant bone. Preparation of an osteotomy results in a narrow zone of dead and dying osteocytes in peri-implant bone that is not significantly enlarged in response to implants placed with low IT. Placing implants with high IT more than doubles this zone of dead and dying osteocytes. As a result, peri-implant bone develops micro-fractures, bone resorption is increased, and bone formation is decreased. Using high IT to place an implant creates high interfacial stress and strain that are associated with damage to peri-implant bone and therefore should be avoided to best preserve the viability of this tissue.
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA Orthodontic Department, College of Dentistry, Yonsei University, Seoul, South Korea.
authors: J Y
authors: JY
authors: Cha
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA.
authors: M D
authors: MD
authors: Pereira
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA.
authors: A A
authors: AA
authors: Smith
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA.
authors: K S
authors: KS
authors: Houschyar
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA State Key Laboratory of Oral Disease, West China Hospital of Stomatology, Sichuan University, Chengdu, China.
authors: X
authors: X
authors: Yin
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA.
authors: S
authors: S
authors: Mouraret
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA.
authors: J B
authors: JB
authors: Brunski
authors: Division of Plastic and Reconstructive Surgery, Department of Surgery, Stanford School of Medicine, Stanford, CA, USA jhelms@stanford.edu.
authors: J A
authors: JA
authors: Helms
mesh_terms: D000818:Animals; D017209:Apoptosis / Q000502:physiology; D001696:Biomechanical Phenomena; D016723:Bone Remodeling / Q000502:physiology; D001862:Bone Resorption / Q000503:physiopathology; D002113:Calcification, Physiologic / Q000502:physiology; D016923:Cell Death / Q000502:physiology; D002470:Cell Survival / Q000502:physiology; D003094:Collagen / Q000378:metabolism; D003758:Dental Implantation, Endosseous / Q000379:methods; D015921:Dental Implants; D003764:Dental Materials / Q000737:chemistry; D017268:Dental Prosthesis Retention; D055119:Elastic Modulus; D005269:Femur / Q000033:anatomy & histology* / Q000293:injuries / Q000601:surgery; D020342:Finite Element Analysis; D008297:Male; D051379:Mice; D016348:Osseointegration / Q000502:physiology; D010011:Osteocytes / Q000473:pathology; D010012:Osteogenesis / Q000502:physiology; D010027:Osteotomy / Q000379:methods; D018583:Pliability; D013314:Stress, Mechanical; D013499:Surface Properties; D014025:Titanium / Q000737:chemistry; D019415:Torque
chemical_list: D015921:Dental Implants; D003764:Dental Materials; D003094:Collagen; D014025:Titanium
keywords: biological process; dental implantation; finite element analysis; orthodontic anchorage techniques; osseointegration; prosthesis implantation
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