Bone Physiology and Wound Healing

The events involved in osseous wound healing around implants recapitulate the events of wound healing which is depicted in the flowchart.

The effect of many inflammatory mediators, eicosanoids, interleukins and is it chemokines  on bone formation and osteoblast behaviour in culture strongly implicates the implication of post surgical inflammatory processes in determination of bone formation.

After the establishment of a well vascularised, immature connective tissue, osteogenesis continues by the recruitment, proliferation and differentiation of the osteoblastic cells. Differentiated osteoblast secretes a collagenous matrix and contributes to its mineralization.

Eventually during the formation, the matrix surrounds the osteoblastic cells and mineralization of a collagenous rich matrix is completed. This cell rich and unorganized bone is called woven bone. The transformation of woven bone to lamellar bone i.e. bone organized to resist physical strain and displaying a haversian architecture, is another important part of osseointegration. Thus, osseointegration involves the direct bone apposition on the implant surface followed by the structural adaptation of the bone to mechanical load and represents a lifelong process of bone formation, adaptation to function and repair of bone