Placement Of Endosseous Implants Research Articles

Аналіз поширеності часткових дефектів зубних рядів та потреби в кістковій пластиці з метою встановлення ендоосальних імплантатів при дистально-необмежених дефектах зубних рядів

Relevance of research. In planning the treatment of partial edentulousness, the Kennedy classification of dentition defects plays an important role in the choice of the type and design of the prosthesis. The structure and morphology of dentition defects, in particular distally unlimited ones, is of great importance in the context of planning effective prosthetic rehabilitation of patients, including pre-prosthetic surgical preparation. The purpose of the study: to investigate the prevalence and structure of dentition defects and the need for bone grafting for the placement of endosseous implants in distally unlimited dentition defects for successful prosthetic rehabilitation. Materials and methods. Radiological, statistical and digital modelling methods were used for the study. Results and discussion. Partial absence of teeth is one of the most common types of pathology of the dental system. According to the results of the analysis of 198 computed tomography scans of the jaws, 76.76% of patients aged 25-60 years had partial defects in the dentition. Distally unlimited defects were found in 46.35% of jaws with partial edentulousness in the age group of 25-60 years. It should be noted that 15.7% of patients had combined distally unlimited defects of the dentition on both jaws. Based on the study data, a large percentage (42.37%) of jaws with Kennedy class I dentition defects that required bone grafting was noted, and a slightly lower percentage (26.53%) of those requiring bone grafting in Kennedy class II. Conclusions. The results of the study indicate the need for careful planning of the surgical and orthopedic stages of implantsupported prosthetics, risk assessment and, to some extent, delay of the final stage of prosthetic rehabilitation of patients with distally unlimited dentition defects. Key words: distally unlimited defects of the dentition, Kennedy classification, bone grafting, endosseous implants.

A Study of 42 Partially Edentulous Patients with Single-Crown Restorations and Implants to Compare Bone Loss Between Crestal and Subcrestal Endosseous Implant Placement.

BACKGROUND The purpose of the study was to evaluate the influence of dental implant placement at different bone levels upon the resultant postoperative peri-implant bone loss. MATERIAL AND METHODS Forty-two partially edentulous patients seeking implant-supported single-crown restorations were screened followed by segregation into 2 groups (GP), GP E (equicrestal) and GP S (subcrestal) (n=21 each). Sixty endosseous implants (30 each) (Adin Tourage-S, Israel), size 3.5/8 and 4/10 mm for mandibles, were placed using a 2-stage surgical procedure. At 4 to 6 months, straight abutments were attached followed by restoration (Vita Zahnfabrik, Germany). Crestal bone levels (mesial/distal) of implant fixtures were assessed at 5 time intervals (after surgery, and at 3, 6, 9, and 12 months) using digital radiography. Means and standard deviations were calculated, following which the differences were statistically analyzed using ANOVA at P value of <0.05. RESULTS The mean annual bone loss for GP S (1.96 mm) was higher than GP E (1.10 mm). At all studied time intervals, the bone loss for implants in GP S was higher than in GP E (P<0.05). Between time intervals, lowest bone loss was observed on the distal side in GP E (0.11 mm/6-9 month) and the highest bone loss was observed on the distal side of GP S (0.6 mm/9-12 month). Differences in the means between the 2 groups on mesial and distal sides were statistically significant at all time intervals (P<0.05). CONCLUSIONS Subcrestal implant placement was associated with more bone loss than when implants are placed at the crestal level.

Minimally Invasive Dentistry: Step by Step of an Anterior Adhesive Bridge

Fixed Partial Dentures (PPF/FPD) bonded with resin cement are viable alternatives based on the fundamentals of Minimally Invasive Dentistry (MIO). The conservative concept of preserving healthy dental tissue allows planning a minimally invasive restorative approach. Nowadays, remain uncertain how to replace teeth in patients with edentulous spaces that are not suitable for implant placement or with limited economic factors. The current ceramic systems provide greater bond strength to the substrate while offering an optimal aesthetic result. Clinical and laboratory investigations demonstrate the adequate long-term clinical performance of fixed partial dentures bonded with resin cement. The present clinical case will be approached in an even more conservative way, without the unnecessary removal of healthy dental tissue, replacing a tooth with a unitary fixed partial prosthesis in a patient not suitable for the placement of endosseous implants.

An Anatomic Analysis of Fibula Flap Mandible Reconstructions: Implications for Endosseous Implant Placement.

Precise planning and evaluation of the fibula bone are necessary if immediate endosseous implant placement is considered. Limited information is available on the anatomical dimensions or density of fibula used in mandibular reconstructions. This study aimed to describe the morphology and dimensions of the fibula used to reconstruct segmental mandibular defects and contrast the findings with the native mandible. A retrospective analysis was performed of patients who underwent segmental mandibulectomy reconstructed with osteocutaneous fibula flaps and had at least one postoperative computed tomography scan. Fibula cross sectional dimensions and densities were evaluated with three-dimensional software. Radiographic measurements were obtained from the contralateral mandible medial to the first molar for comparison. Four hundred seventy-seven fibula cross sections from 159 segments were evaluated. Cross-sectional oval, quadrilateral, triangular, and pentagonal shapes differed significantly in proportion (p < 0.001). Thirty-eight percent of segments (95 percent CI, 30 to 46 percent) had differences in cross-section height greater than 1 mm (p < 0.001). Between segments within the same patient, the median height difference was 1.58 mm (range, 0.14 to 6 mm). The superior cortex density was significantly higher for the fibula than the native mandible; however, the medullary space density was significantly lower (p < 0.001). The current study comprises the most comprehensive description of fibula morphology in mandibular reconstructions and highlights the significant variability that exists. The findings provide justification for the added time and cost of computer-aided design and computer-aided manufacturing in centers interested in performing immediate dental implant placement, as the technology provides the necessary precision and accuracy.

Platelet-rich plasma in maxillary sinus augmentation, direct maxillary sinus floor augmentation

The placement of endosseous implants in posterior edentulous maxilla is normally a challenging task in implant dentistry due to maxillary sinus pneumatization. Various sinus augmentation techniques have been used with impressive success rates aimed at developing these sites for implant placement. Knowledge of anatomy of maxillary sinus guides us not only in proper preoperative treatment planning but also helps us to avoid the possible complications that may arise during sinus augmentation procedure. This topic attracts a rising number of publications with most of them reporting results that suggest, the patients with atrophic maxilla requiring implant treatment can benefit considerably from the use of sinus augmentation. This article explains the basic technique namely direct techniques used for maxillary sinus elevation and augmentation.

CBCT Analysis of Prevalence of the Canalis Sinuosus on the Alveolar Ridge in the Site of Endosseous Implant Placement: A Retrospective Study.

This study aimed to perform a cone-beam computed tomography (CBCT) analysis in the Chennai population to check for the prevalence of the canalis sinuosus and its terminal branches in the site of endosseous implant placement in the alveolar ridge of the anterior maxilla. A retrospective analysis was conducted in Saveetha Dental College, Chennai. One hundred (50 male and 50 female) CBCT images that included the maxilla of patients aged 18-65 years were selected at random from the archives of the Oral Implantology Department, which were taken in the period from December 1, 2019 to November 30, 2020. Two examiners assessed all the scans with special training to identify this structure. The CBCTs were examined carefully for the presence of accessory canals and the side of occurrence, gender, relation in proximity to the anterior teeth (central incisors to the first premolar). The diameter of the canal was also noted as either less than 1 mm or greater than 1 mm. Our study showed that accessory canals of the canalis sinuous were identified in a total of 18 patients (4 female, 14 male). This shows that in our study, the prevalence of this structure amongst male patients was 14% and for female patients, it was 4%. This study shows that although the accessory canals of the canalis sinuous in the site of endosseous implant placement are rare, it must not be taken lightly because its occurrence still poses a significant risk of iatrogenic nerve damage, especially during implant placement procedures. In some individuals, the terminal branches of this canal or its accessory canals can sometimes be present in the site of placement of endosseous implants placed in the anterior maxilla. Lack of knowledge and awareness of this structure and the fact that its occurrence is often overlooked due to its rare occurrence causes the potential for iatrogenic damage to the nerve resulting in complications.

Combined Endoscopic and Intraoral Approach or Intraoral Alone in Surgical Management of Odontogenic Sinusitis

The physiological behavior of paranasal sinuses depends on the potency of the ostiomeatal complex and on normal mucociliary function. The interruption of this delicate equilibrium can lead to pathological conditions such as sinusitis. Anywhere between 10% and over 25% of cases of maxillary sinusitis have an odontogenic origin, such as: dental infection; alveolar dental trauma; or iatrogenic causes, such as extractions, endodontic therapies, maxillary osteotomies or placement of endosseous implants. The resolution of sinus pathology is related to the resolution of odontogenic pathology. Aim: to evaluate the therapeutic efficacy of a combined oral and endoscopic approach in the treatment of chronic odontogenic sinusitis vs. oral dental management through a case control study. Materials and Methods: all patients showing signs and symptoms of odontogenic sinusitis with obliteration (appreciable radiopacity in CT) of unilateral maxillary sinus between January 2018 and September 2019 at Padua University Hospital were enrolled in this retrospective study. The exclusion criteria were: maxillary sinusitis without odontogenic origin, or resolution with a systemic antibiotic therapy; and presence of anatomical abnormalities that promote the onset of rhinosinusitis. The patients were divided into two groups: one group was treated with a combined surgical approach under general anesthesia (Functional Endoscopic Sinus Surgery-FESS and simultaneous closure of oroantral communication with Bichat’s fat pad advancement); while the other group was treated only with an intraoral approach under local anesthesia and conscious sedation (closure of oroantral communication with Bichat’s fat pad advancement). The variable “success of the surgical procedure” in the two groups was compared by a Student test (with p &lt; 0.05). Results: among the patients enrolled, 10 patients (aged between 42 and 70) made up the case group and the other 10 patients (aged between 51 and 74) constituted the control group. There was no statistically significant difference in success between the two groups (p &lt; 0.025). Conclusions: according to this case study, an exclusive annotation invasive intraoral approach seemed to be comparable to the transoral endoscopic combined method. However, during diagnosis it is necessary and fundamental to distinguish between odontogenic and rhinogenic sinusitis in order for the resolution of odontogenic sinusitis to be achieved.

Horizontal maxillary ridge augmentation with ridge split procedure and simultaneous implant placement: A case report

Treatment of edentulous maxillary anterior region with horizontal ridge atrophy presents a clinical situation in which the placement of endosseous implants might be complex or sometimes impossible without a ridge augmentation procedure. This case report presents management of horizontally deficient maxillary anterior ridge with ridge split procedure using piezotome and simultaneous implant placement. In contrast to other ridge augmentation techniques, ridge splitting allows for immediate implant placement following surgery reducing the overall treatment time and eradicates the possible morbidity from a second surgical site.

Oral Rehabilitation of an Adult Cleft Palate Patient with Zygomatic Implant-supported Obturator Prosthesis: A Case Report

IntroductionWith advancement in medical services and their accessibility across the country, as well as growing awareness among the patient population, it is rare to find an adult with an untreated cleft lip and/or palate nowadays. Treatment of these patients to restore form and function can be challenging, often yielding less-than-satisfactory outcomes. In current literature, there have been case reports of patients with atrophic maxilla or severe maxillary defects after oncologic resections, where zygomatic implants have been utilized for fabrication of a fixed maxillary prosthesis.Here, the authors present a case of an adult cleft palate patient treated with a zygomatic implant-supported removable obturator prosthesis, which has not yet been reported in literature. BackgroundThe patient is a 66-year-old female who presented to the University of Maryland Oral & Maxillofacial Surgery Associates in 2016 for management of an untreated bilateral cleft palate. She had been wearing an obturator for several years prior that had slowly lost retention over time due to ridge resorption. Patient had undergone multiple procedures for placement of endosseous implants to support a fixed prosthesis as well as sinus lift surgeries, all of which had failed. She had 1 clinically osseointegrated implant in the right maxilla that was restorable. The patient did not wish to pursue any extensive surgical interventions, so after consultation with a maxillofacial prosthodontist at the authors' unit, the decision was made to pursue a zygomatic implant-supported obturator prosthesis fabrication to restore the patient's form and function. Surgical techniqueThe patient underwent general anesthesia induction and nasotracheal intubation. Mucoperiosteal flaps were reflected bilaterally in the oral cavity along the maxillary alveolar ridge, extending up to orbital rims and laterally over the zygomatic eminence. Sinus windows were created for visualization of twist drills. Osteotomies were created in the zygomatic bone using NobelBiocare protocol, and 2 35mm implants were inserted in the left zygoma, and a 45mm implant was placed on the right-side mesial to the existing endosseous implant. Left maxillary palatal side was grafted with particulate bone, and cover screws were placed. Soft-tissue closure was with 3-0 chromic gut sutures. Implants were buried for 6 months, then uncovered and restored using locator bars to connect implants in each alveolar segments, which would, in turn, support the maxillary obturator. ResultsThe patient has been compliant with follow-ups and last seen in August 2020. She reported good function without any nasal regurgitation and was satisfied with retention and stability of her prosthesis. On examination of her oral cavity after obturator removal, the tissues were healthy-appearing, and the locator housings were evaluated and found to be in good shape and retentive. Radiographically, the implants were stable without signs of bone loss. ConclusionThe authors have found that zygomatic implants can be utilized as an alternative to support an obturator prosthesis. However, given lack of long-term follow-up in literature, some reservations must be expressed in its use, especially when other predictable alternatives are available.

Piezoelectric driven mandibular ridge split technique with immediate implant placement: A case report

Narrow dentoalveolar ridges pose a major challenge for the successful placement of endosseous implants. This case report focuses on a Piezoelectric driven mandibular Ridge Split technique without vertical osteotomy for an immediate implant placement in a narrow alveolar ridge measuring 3.0mm.Following anaesthesia, a mucoperiosteal flap was elevated after giving a mid-crestal incision distal to 35 along the entire edentulous ridge. Then, with the help of a micro-saw and horizontal spreaders, an osteotomy site of required diameter was achieved. Finally twist drills were used and implants were placed in the expanded site.Clinically, healing was uneventful with no step defect in the expanded buccal bone and the final occlusion obtained was satisfactory.The Piezo-electric driven Ridge Split technique promises to be a minimally invasive option for horizontal augmentation of narrow alveolar ridges- predictability within a short interval of time and with minimal risk of fracture.

Simultaneous Placement of Endosseous Implants in Free Fibula Flap for Reconstruction of Mandibular Resection Defects.

Functional reconstruction of the jaw defect due to tumor resection poses a challenging problem in maxillofacial surgery. Large bone defects in the mandible due to ablation for tumors may generate a series of problems, as far as function and esthetics of the patient is concerned. The use of free bone flaps for mandibular reconstruction has the obvious advantage of being a well vascularized tissue that can withstand the hostile environment of the oral cavity. Fibular bone presents favorable conditions for implant-supported prosthetic rehabilitation, due to its diameter and the good quality of its cortical bone. The outcome of current study supports the use of simultaneous placement of endosseous implants in free fibula flap for reconstruction of mandibular resection defects with better clinical, aesthetic, and functional outcomes.

Comparison between immediate vs. delayed lateral expansion technique to augment narrow alveolar ridges for placement of implants - A pilot study

ObjectiveNarrow alveolar ridges pose a serious challenge for successful placement of endosseous implants and alveolar ridge widening procedure is indicated in cases of crest thickness of ≤4.0 mm. The study evaluated and compared, immediate and delayed techniques of implant placement using split crest technique to augment atrophic narrow alveolar ridges. MethodsThe study was carried out in 10 patients randomly divided into two groups of five each for immediate or delayed placement of implants. Implants were placed simultaneously after split crest procedure in immediate technique and after 3–4 weeks of healing in delayed technique. Data collected was statistically analyzed by SPSS version 22 using unpaired t-test, ANOVA and Pearson's correlation with p value = 0.05. ResultsStatistically significant (p = 0.000) difference was observed for implant stability at intra-op, 4 months and 6 months post-op between the two groups, however there was no statistically significant difference in amount of augmentation achieved between the two groups. ConclusionWe observed that both the techniques were comparable on the basis of augmentation achieved, implant success and survival rates, whereas implant stability was significantly higher in delayed technique group.

Aminogam® Gel Allows Faster Wound Healing after Oral Surgery by Formation of Mature Connective Tissue with Low Vascular Density and Reducing Inflammatory Infiltration. A Retrospective Study on 580 Cases with Histological and Confocal Laser Investigation

Reduction of the wound healing time after surgical procedures along with good hemostasis, and the reduction of post-surgical edema, pain and infective complications are generally desirable to both clinicians and patients. Recently, a gel compound containing sodium hyaluronate and four synthetic aminoacids (glycine, leucine, proline, lysine) and marketed as Aminogam® (Errekappa Euroterapici, Italy), has been proposed as a medical device promoting faster wound healing after oral surgery procedures. To assess its achievable clinical benefits, we studied retrospectively 580 cases (290 study cases and 290 control cases) undergoing oral surgery and receiving Aminogam ® gel application. More precisely, cases were divided into 7 groups on the bases of the kind of surgery (teeth extraction, oral surgery in patients taking bisphosphonates, surgical treatment of jaw osteonecrosis related to bisphosphonates therapy, placement of endosseous implants, diode laser surgery of oral mucosa lesions with second intention healing without stitches, diode laser photocoagulation of slow flow vascular malformations and bone surgery). In all instances, Aminogam® gel was applied at least five times a day until the wound healed completely. We compared the elapsed time between surgery and complete healing with Aminogam® application compared to control cases receiving no other drug treatment. Our results confirmed that the overall time of healing is certainly reduced in cases receiving Aminogam® gel regardless of the kind of oral surgery.

Utilizing autologous growth factors enriched bone graft matrix (sticky bone) and Platelet rich fibrin (PRF) membrane to enable dental implant placement: A case report

Introduction: Dental implants are the most innovative and superior treatment in dentistry, and are widely used. However, the intended implant site may be inappropriate due to the poor bone quality or insufficient bone volume. When extensive loss of alveolar bone is encountered it presents a complex challenge for reconstruction. Numerous augumentation technique are used for alveolar reconstruction and to create sufficient bone volume for placement of endosseous implants. In order to accelerate healing of bone graft over the bony defect, numerous techniques utilizing platelet and fibrinogen concentrations have been introduced in the literature. Sticky bone provides stabilizationof bone graft in the defect, and therefore, accelerates tissue healing and minimizes bone loss during healing period. Due to formation of homogenous mass of bone graft particles, handling and adaptation of bone graft becomes easy. The use of sticky bone also avoids complex ridge augumentation procedures. Aim: The aim of this case report is to demonstrate the use of sticky bone and autologous PRF membrane in hard tissue regeneration and maintenance of volume of alveolar ridge to enable dental implant placement. Material and Methods: Ridge augmentation was done in defect using sticky bone formed by cera bone granules of particle size 0.5-1.0 mm and PRF membranes. Results: Sufficient bone volume was achieved through GBR as shown by comparing presurgical and post 3months CT and clinically it can be seen at second stage surgery done after 3 months. Conclusion: The result suggested that GBR with autologous PRF membranes is sufficient for augmentation of localised alveolar ridge defects with conjunction with sticky bone. Sticky bone provides stabilization of bone graft in defect and improves handling properties and PRF membranes act as barrier membrane as well as source of accelerated growth factor release. Keywords: Dental implant, Sticky bone, and Platelet rich fibrin (PRF) membrane.

Immediate Dental Implantation in Oncologic Jaw Reconstruction: Workflow Optimization to Decrease Time to Full Dental Rehabilitation.

Summary:Full dental rehabilitation following segmental mandibulectomy or maxillectomy for oncologic tumor ablation should be the goal for every patient. But despite advances in technology and reconstructive techniques, many patients do not achieve timely or complete oral rehabilitation. Recognizing this fault, we recently adopted an innovative workflow to increase the number of patients undergoing dental restoration, irrespective of tumor pathology or need for adjuvant radiotherapy. Preoperatively, every osseous jaw reconstruction undergoes virtual surgical planning to incorporate the placement of endosseous implants into the fibula osteocutaneous free flap. The dental implants are then placed intraoperatively at the time of tumor ablation and reconstruction. Four-to-six weeks following the initial surgery, the patient returns to the operating room for vestibuloplasty and exposure of the dental implants. Within 3 days of the vestibuloplasty, a temporary dental prosthesis is placed in the dental clinic, and the patient can then begin radiation therapy if needed. Following adjuvant radiation therapy, the temporary prosthesis can be replaced with a permanent one. At our institution, this innovative workflow has allowed for earlier aesthetic restoration of the jaw and greatly expanded the number of patients able to achieve oral rehabilitation. Herein, we describe this innovative workflow and provide technical pearls for successful execution.

Maxillary sinus augmentation.

The placement of endosseous implants in posterior edentulous maxilla is normally a challenging task in implant dentistry due to maxillary sinus pneumatization. Various sinus augmentation techniques have been used with impressive success rates aimed at developing these sites for implant placement. Knowledge of anatomy of maxillary sinus guides us not only in proper preoperative treatment planning but also helps us to avoid the possible complications that may arise during sinus augmentation procedure. This topic attracts a rising number of publications with most of them reporting results that suggest, the patients with atrophic maxillae requiring implant treatment can benefit considerably from the use of sinus augmentation. This article explains the basic techniques, namely, direct and indirect techniques used for maxillary sinus elevation and augmentation.

Evaluation of piezotomed alveolar ridge splitting with stereolithographic surgical guide for implant placement (clinical study)

IntroductionNarrow dentoalveolar ridges remain a serious challenge for the successful placement of endosseous implants. Several techniques for this procedure may be considered, such as guided bone regeneration, bone block grafting, and ridge splitting for bone expansion. The ridge split procedure provides a quicker and a more reliable method. Advances in technology, Stereolithography allow fabrication of surgical guide from 3D generated models for precise implant placement. ObjectivesEvaluation of minimally invasive ridge splitting procedure aided with surgical guide. Materials and methodsA clinical study was performed on a total of 7 patients with mandibular free end saddle. The sample was selected conveniently to fulfill a list of inclusion and exclusion criteria. Then the selected participants performed ridge splitting with the aid of surgical guide. After ridge splitting, all patients had simultaneous implant placement followed by clinical and radiographical evaluation over a period of 6 months. ResultsMerging the preoperative, immediate and 6 months postoperative CBCT images showed statistically significant values of accuracy and increase in bone width and bone density. ConclusionAlveoalar ridge splitting with the aid of stereolithographic surgical stent is a well acceptable technique for implant placement.

Sandwich bone graft for vertical augmentation of the posterior maxillary region: a case report with 9-year follow-up

The loss of teeth followed by bone resorption often lead to defects in the alveolar ridge, making installation of dental implants difficult. Correction of such bone defects, especially lack of height of the ridge, is a difficult problem for all dental surgeons. This report describes the outcome of treatment after alveolar ridge augmentation in the atrophic posterior maxillary region via segmental sandwich osteotomy combined with placement of an interpositional autograft prior to placement of endosseous implants. The technique was successfully used to treat a deficiency in the vertical dimension of the posterior maxillary region. Six months after graft surgery, two implants were successfully placed in accordance with the original treatment protocol, and they survived for 9 years of follow-up.

EVALUATION OF PIEZOTOMED ALVEOLAR RIDGE SPLITTING WITH STEREOLITHOGRAPHIC SURGICAL GUIDE FOR IMPLANT PLACEMENT

INTRODUCTION: Narrow dentoalveolar ridges remain a serious challenge for the successful placement of endosseous implants. Several techniques for this procedure may be considered, such as guided bone regeneration, bone block grafting, and ridge splitting for bone expansion. The ridge split procedure provides a quicker and a more reliable method. Advances in technology, Stereolithography allow fabrication of surgical guide from 3D generated models for precise implant placement. OBJECTIVES: Evaluation of minimally invasive ridge splitting procedure aided with surgical guide. MATERIALS AND METHODS: A clinical study was performed on a total of 7 patients with mandibular free end saddle. The sample was selected conveniently to fulfill a list of inclusion and exclusion criteria. Then the selected participants performed ridge splitting with the aid of surgical guide. After ridge splitting, all patients had simultaneous implant placement followed by clinical and radiographical evaluation over a period of 6 months. RESULTS: Merging the preoperative, immediate and 6 months postoperative CBCT images showed statistically significant values of accuracy and increase in bone width. CONCLUSIONS: Alveoalar ridge splitting with the aid of stereolithographic surgical stent is a well acceptable technique for implant placement.

Osteopontin-deficiency disturbs direct osteogenesis in the process of achieving osseointegration following immediate placement of endosseous implants.

The role of osteopontin (OPN) in the process of achieving osseointegration following implantation remains to be clarified. This study aimed to analyze the healing patterns of the bone-implant interface after immediate placement of implants in the maxillae of 4-week-old Opn-knockout (KO) and wild-type (WT) mice. After maxillary first molars were extracted, cavities were prepared with a drill and titanium implants blasted with ceramic abrasives containing hydroxyapatite/β-tricalcium phosphate were placed. Following fixation at 3, 5, 7, and 28 days after implantation, the samples were analyzed using immunohistochemistry, in situ hybridization, and an electron probe micro analyzer. Two types of bone healing were observed in the process of achieving osseointegration: "direct osteogenesis," where bone formation occurs at the implant surface, and "indirect osteogenesis," where it does at the pre-existing damaged bone surface in the WT mice. Direct osteogenesis occurred after the recruitment of tartrate resistant acid phosphatase-positive cells and the deposition of OPN on the implant surface. In contrast, the rate of osseointegration or direct osteogenesis was significantly low, and cell proliferation was disturbed in the Opn-KO mice. These results suggest that Opn-deficiency disturbs direct osteogenesis to lead the delayed osseointegration after immediate placement of endosseous implants.