The primary goal of implant installation is to achieve and

maintain a stable bone-to-implant connection (i.e.,

osseointegration). Histologically, osseointegration is
defined as the direct structural and functional connection
between ordered, living bone and the surface of a load-
bearing implant without intervening soft tissues. Clinically,
osseointegration is the asymptomatic rigid fixation of an
alloplastic material (implant) in bone with the ability to
withstand occlusal forces. The hard tissue interface is a
fundamental requirement for and an essential component of
implant success.
The osseointegration process observed after implant
insertion can be compared to bone fracture healing. Implant
site osteotomy preparation (bone wounding) initiates a
sequence of events, including an inflmmatory reaction, bone
resorption, release of growth factors, and attraction by
chemotaxis of osteoprogenitor cells to the site. Diffrentiation
of osteoprogenitor cells into osteoblasts leads to bone
formation at the implant surface. Extracellular matrix
proteins, such as osteocalcin, modulate apatite crystal
growth. Specific conditions, optimal for bone formation, must
be maintained at the healing site to achieve
osseointegration.