Osteointegration: new and safer horizons
Written by:What does "osseointegration" mean in the 21st century? The Prof speaks of it. Massimo Simion, expert in Dentistry in Milan
Osseointegration has provided us with one of the most predictable treatments in dental medicine, characterized by a success rate of over 95%. 
However, the situation has changed. More and more patients come to our studies with severe inflammation of the peri-implant tissues associated with severe and progressive bone loss.
But let's analyze the stages: between the years 60 and 80 Professor Branemark developed the concept of osseointegration and, until the years 2000, this system was used extensively and successfully all over the world to treat thousands of totally and partially edentulous patients. A particular feature of the system was the use of a cylindrical implant with a single thread and a relatively smooth surface.
Since the 2000s, plant manufacturers have started to offer so-called "active surfaces", ie rough surfaces. The aim was to promote better and faster osseointegration, allowing faster healing before implant loading (or in some cases of immediate loading). Since 2005, however, an increasing proportion of patients began to show inflammation of the peri-implant tissues with a gradual loss of bone.
Our confidence in implant treatment is therefore diminished: we no longer feel confident in telling our patients "Your implants will work for your entire life".
Therefore, I believe that researchers, clinicians and companies will have to take collective responsibility to return to the traditional Branemark concept of a plant with at least 50% of smooth surface in its portion closer to the gingiva , and that it will only be loaded after a sufficient period of time to ensure that the bone integrates with the implant.
