Osseointegration—the biological reality of successful dental implant therapy: a narrative review

Abstract

Objective: This article aims to provide an overview of factors affecting dental implant osseointegration. Background: Osseointegration has proven to be a biologically sound foundation for contemporary dental implant therapy. Its success is dependent on principle-driven clinical procedures. Important observations have been made at cellular and macroscopic levels regarding osseointegration at the earliest stages of bone healing to the later stages of bone formation and remodeling. The formation of bone at the titanium dental implant surface is dependent on osteoprogenitor cell recruitment, proliferation and differentiation under complex control. In addition, macrophages play a determinant role in the process of osteoinduction that supports osseointegration. The role of signaling pathways and transcription factors in modulation of cell behavior and fate is critical. The current relatively high success of dental implant therapy is due, in part, to the effects of enhanced surface topography on implant-adherent cell functions. Other immune cells also appear to be influenced by surface topography and impact the process of osseointegration. Immunomodulation plays a key role in determining the bone forming process at endosseous dental implants and underscores the important relationship between the technical aspects of dental implant therapy and the local and systemic biological factors acting upon the population of implant-adherent and adjacent cells. Given the growing knowledge base regarding the complex molecular and cellular basis of osseointegration, it is also possible to reconsider dental implant failure in that context. Methods: The relevant literature was identified and consulted through PubMed/Medline. Conclusions: The success of osseointegration is determined by an array of clinical and molecular factors all of which have to be considered in contemporary dental implant therapy.