Just like any type of wound healing in the body, microbial contamination jeopardizes bone healing. Strict aseptic techniques by the dental team during surgical placement is crucial to implant success. If bone is overheated or damaged during surgical preparation, it will become necrotic leading to soft tissue scar formation. The critical temperature for bone is less than 116.6 degrees F at an exposure time not to exceed one minute. Profuse irrigation with gentle, intermittent, moderate-speed drilling using sharp rotary instruments is required.29 A mild inflammatory response will promote wound healing. However, a moderate inflammatory response or movement above a certain threshold e.g., above 150 um can be detrimental to implant success. Bone tissue damage and debris at the osteotomy site must be cleared by osteoclasts for normal bone healing. These cells originating from the blood can resorb bone at a rate of 50-100 um per day.29 A proper vascular supply and oxygen tension are needed for bone apposition. If oxygen is poor, the stem cells may differentiate into fibroblasts forming scar tissue leading to the nonintegration of the implant and bone and implant failure.9
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