Questions and Answers
What is the primary function of platelets in the hemostasis phase?
To aggregate and form a thrombus to stop bleeding
What is the effect of a hydrophilic implant surface on protein adsorption?
It preserves protein functions and allows for cell attachment
What is the primary function of fibrin cross-links in the hemostasis phase?
To form a provisional matrix on the implant surface
Which protein is responsible for stimulating cell division of fibroblasts?
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What is the consequence of a hydrophobic implant surface on protein adsorption?
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Which protein is responsible for binding to cell adhesion molecules (integrins)?
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What is the effect of platelet aggregation on the implant surface?
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What is the primary function of vitronectin in the implant interaction with the surrounding tissues?
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What do macrophages secrete to antagonize the digestive enzymes and the growth factors stored in the tissue?
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What is the prerequisite for osteogenesis?
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What do pericytes detach from in response to VEGF expression by macrophages?
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What is the result of the arrangement of endothelial cells in angiogenesis?
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What is the role of macrophages in the protective mechanism of the extracellular matrix?
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What is the result of the migration of fibroblasts from the surrounding tissue in response to FGF?
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What is released by platelets during the inflammatory phase?
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What is the role of Histamine during the inflammatory phase?
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What is the result of prolonged presence of bacteria in the wound?
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What is the role of PMNs during the inflammatory phase?
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How can we limit the inflammatory phase?
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What is the role of PDGF and TGF-b during the inflammatory phase?
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What is the role of Macrophages during the inflammatory phase?
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What is the result of angiogenesis during the inflammatory phase?
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Study Notes
Implant Interaction with Surrounding Tissue
- Bleeding is stopped by the aggregation of blood platelets, forming a white thrombus
- Mechanical crushing of bone (bone trauma) releases bone matrix proteins and growth factors
Bone Trauma
- Bone matrix proteins (albumin, fibronectin, vitronectin) are released in high concentration
- These proteins contain cell binding sites that interact with cell adhesion molecules (integrins)
- They can bind more platelets, promoting further platelet aggregation
Implant Interaction with Surrounding Tissue (continued)
- Hydrophobic implant surface leads to protein denaturation, loss of function, and platelet aggregation
- Hydrophilic implant surface preserves protein function, allowing cells to attach to the implant surface
Hemostasis Phase
- Platelets release messenger substances (thromboxane) that allow more platelets to aggregate
- Platelets also release PDGF, which stimulates cell division of fibroblasts and fibrin cross-linking
- Fibrin cross-links form a provisional matrix that adheres to the implant surface
Inflammatory Phase
- Platelets release various messenger substances, including TGF-b, PDGF, FGF, histamine, and bradykinin
- PDGF, TGF-b, and FGF play a significant role in blood vessel formation (angiogenesis)
- Histamine increases vascular permeability, allowing fluid and serum proteins to flow into the site
- Bradykinin increases blood flow and hyperemia
- PMNs (neutrophils) are attracted to the site by chemotaxis, where they kill bacteria and release digestive enzymes
Limiting Inflammatory Phase
- Clean surgical work, antibiotics, and local disinfection can limit the inflammatory phase
- Macrophages eliminate bacteria by phagocytosis and remove tissue debris
- Macrophages also secrete angiogenic and fibrogenic growth factors (PDGF, bFGF, VEGF)
Proliferative Phase
- Formation of granulation tissue through angiogenesis and new extracellular matrix formation
- Angiogenesis is a prerequisite for osteogenesis
- Macrophages express VEGF, stimulating pericytes to detach from the outer wall of the vessel
- Pericytes then stimulate the production of endothelial cell precursors, leading to angiogenesis
