Alveolar Bone Density and Width Affect Primary Implant Stability

Primary implant stability (PIS) depends on surgical technique, implant design, and recipient bone characteristics, among other factors. Bone density (BD) can be determined in Hounsfield units (HUs) using cone beam computerized tomography (CBCT). Reliable prediction of PIS could guide treatment decisions. We assessed whether PIS was associated with recipient bone characteristics, namely, BD and alveolar ridge width (ARW), measured preoperatively by CBCT. We studied a convenience sample of 160 implants placed in 48 patients in 2016 and 2017. All underwent CBCT with a radiologic/surgical guide yielding values for ARW and BD. PIS measures used were the implant stability quotient (ISQ) from resonance frequency analysis and insertion torque (IT). IT was most influenced by the HU value at 0.5 mm outside the implant placement area, followed by the value within this area, and ISQ by the HU value at 0.5 mm outside the placement area, followed by implant placement site and apical ARW. ISQ values were significantly related to ARW in coronal (P < .05), middle (P < .01), and apical (P < .01) thirds. ISQs were higher with larger-diameter implants (P < .01). ISQ and IT were strongly correlated (P < .001). PIS in terms of ISQ and IT is positively correlated with edentulous alveolar ridge BD measured by CBCT, implying that implant stability may be predicted preoperatively. Wide alveolar ridges favored lateral PIS but did not affect rotational PIS. The most significant predictor of lateral and rotational PIS in our patients was the HU value at 0.5 mm outside the implant placement area.

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New Implant Design with Midcrestal and Apical Wing Thread for Increased Implant Stability in Single Postextraction Maxillary Implant

Case Reports in Dentistry ◽

10.1155/2019/9529248 ◽

2019 ◽

Vol 2019 ◽

pp. 1-4 ◽

Cited By ~ 1

Author(s):

Antonio Scarano ◽

Bartolomeo Assenza ◽

Francesco Inchingolo ◽

Filiberto Mastrangelo ◽

Felice Lorusso

Keyword(s):

Cortical Bone ◽

Dental Implant ◽

Alveolar Bone ◽

Primary Stability ◽

Implant Design ◽

Insertion Torque ◽

Fixture Design ◽

Implant Stability ◽

Implant Placement ◽

Immediate Placement

Background. The immediate placement of a dental implant could represent an option treatment for the rehabilitation of a postextractive missing tooth socket to replace compromised or untreatable teeth, with the advantage of single-session surgery. In this way, the anatomy of the alveolar bone defect, the preservation of the buccal cortical bone, and the primary stability of the fixture represent the critical factors that consent a precise implant placement. Objective. This case report describes a novel fixture design for postextractive alveolar socket immediate implant. Methods. Two patients (25 and 31 years old) were treated for postextractive dental implant placement to replace both central upper incisor teeth with four implants. The residual bone implant gap was not filled with graft or bone substitute. The restoration was provided following a standard loading protocol by a cement-sealed prosthetic abutment. Results. Clinically, all implants positioned showed an excellent insertion torque. No postoperative complications were reported. At 6 months of healing, the buccal cortical bone and the implant stability were present and well maintained. Conclusion. The evidence of this study allows us to underline the possible advantages of this new fixture design for postextractive implant technique.

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Bone Density and Implant Primary Stability. A Study on Equine Bone Blocks

Dentistry Journal ◽

10.3390/dj7030073 ◽

2019 ◽

Vol 7 (3) ◽

pp. 73 ◽

Cited By ~ 2

Author(s):

Francesco Orlando ◽

Federico Arosio ◽

Paolo Arosio ◽

Danilo Alessio Di Stefano

Keyword(s):

Mechanical Properties ◽

Bone Density ◽

Alveolar Bone ◽

Linear Regression Analysis ◽

Primary Stability ◽

Insertion Torque ◽

Implant Stability ◽

Primary Implant ◽

Physical Density ◽

Equine Bone

Previous results on synthetic blocks mimicking bone indicate that bone density can be measured by the friction encountered by a rotating probe while it descends into bone, and that primary implant stability may be measured through the integral (I) of the torque–depth curve at implant insertion. This study aims to repeat those tests on collagen-preserving equine bone blocks as they better reproduce the mechanical properties of natural bone. Fifteen cancellous equine blocks had their density measured using a measuring probe. This was compared to their known physical density through linear regression analysis. Implant placement was carried out into six cancellous equine blocks and primary stability was measured using (I), as well as the insertion torque (IT), the implant stability quotient (ISQ), and the reverse torque (RT). The relation between (I), (IT), (ISQ), and (RT) was investigated by correlation analysis. Bone density measured using the probe correlated significantly with actual density, both with (r = 0.764) and without irrigation (r = 0.977). (I) correlated significantly with IT and RT under all irrigation conditions, and with ISQ only without irrigation (r = 0.886). The results suggest that the probe provides actual bone density measurements. They also indicate that (I) measures primary implant stability and is more sensitive to density variations than IT, RT, and ISQ. Results are consistent with those obtained on synthetic blocks but suggest that equine bone blocks may better reproduce the mechanical properties of human cancellous alveolar bone. This should be the subject of additional studies.

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Correlation of cone beam CT-derived bone density parameters with primary implant stability assessed by peak insertion torque and periotest in the maxilla

Journal of Cranio-Maxillofacial Surgery ◽

10.1016/j.jcms.2019.01.002 ◽

2019 ◽

Vol 47 (3) ◽

pp. 461-467 ◽

Cited By ~ 4

Author(s):

Samer G. Hakim ◽

Julia Glanz ◽

Markus Ofer ◽

Daniel Steller ◽

Peter Sieg

Keyword(s):

Bone Density ◽

Cone Beam Ct ◽

Cone Beam ◽

Insertion Torque ◽

Implant Stability ◽

Primary Implant

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Insertion torque/time integral as a measure of primary implant stability

Biomedical Engineering / Biomedizinische Technik ◽

10.1515/bmt-2020-0039 ◽

2020 ◽

Vol 65 (6) ◽

pp. 729-733

Author(s):

Tanja Grobecker-Karl ◽

Matthias Karl ◽

Constanze Steiner

Keyword(s):

Cortical Layer ◽

Implant Design ◽

Insertion Torque ◽

Resonance Frequency Analysis ◽

Implant Stability ◽

Time Integral ◽

Primary Implant ◽

Medium Quality ◽

Bone Level

AbstractThe goal of this in vitro study was to determine the insertion torque/time integral for three implant systems. Bone level implants (n = 10; BLT – Straumann Bone Level Tapered 4.1 mm × 12 mm, V3 – MIS V3 3.9 mm × 11.5 mm, ASTRA – Dentsply-Sirona ASTRA TX 4.0 mm × 13 mm) were placed in polyurethane foam material consisting of a trabecular and a cortical layer applying protocols for medium quality bone. Besides measuring maximum insertion torque and primary implant stability using resonance frequency analysis (RFA), torque time curves recorded during insertion were used for calculating insertion torque/time integrals. Statistical analysis was based on ANOVA, Tukey’s honest differences test and Pearson product moment correlation (α = 0.05). Significantly greater mean maximum insertion torque (59.9 ± 4.94 Ncm) and mean maximum insertion torque/time integral (961.64 ± 54.07 Ncm∗s) were recorded for BLT implants (p < 0.01). V3 showed significantly higher mean maximum insertion torque as compared to ASTRA (p < 0.01), but significantly lower insertion torque/time integral (p < 0.01). Primary implant stability did not differ significantly among groups. Only a single weak (r = 0.61) but significant correlation could be established between maximum insertion torque and insertion torque/time integral (p < 0.01) when all data from all three implant groups were pooled. Implant design (length, thread pitch) seems to affect insertion torque/time integral more than maximum insertion torque.

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Evaluation of a Novel Cone Beam Computed Tomography Scanner for Bone Density Examinations in Preoperative 3D Reconstructions and Correlation with Primary Implant Stability

Clinical Implant Dentistry and Related Research ◽

10.1111/cid.12193 ◽

2013 ◽

Vol 17 (5) ◽

pp. 844-853 ◽

Cited By ~ 23

Author(s):

Lars Sennerby ◽

Peter Andersson ◽

Luca Pagliani ◽

Claudio Giani ◽

Giacomo Moretti ◽

...

Keyword(s):

Computed Tomography ◽

Bone Density ◽

Cone Beam Computed Tomography ◽

Cone Beam ◽

Implant Stability ◽

3D Reconstructions ◽

Primary Implant ◽

Computed Tomography Scanner

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Does intraoperative bone density testing correlate with parameters of primary implant stability? A pilot study in minipigs

Clinical and Experimental Dental Research ◽

10.1002/cre2.224 ◽

2019 ◽

Vol 5 (6) ◽

pp. 594-600 ◽

Cited By ~ 1

Author(s):

Tanja Grobecker‐Karl ◽

Victor Palarie ◽

Sonja Schneider ◽

Matthias Karl

Keyword(s):

Pilot Study ◽

Bone Density ◽

Implant Stability ◽

Primary Implant ◽

Bone Density Testing

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Efficacy of Alveolar Ridge Preservation: A Randomized Controlled Trial

Journal of Dental Research ◽

10.1177/0022034520905660 ◽

2020 ◽

Vol 99 (4) ◽

pp. 402-409 ◽

Cited By ~ 7

Author(s):

G. Avila-Ortiz ◽

M. Gubler ◽

M. Romero-Bustillos ◽

C.L. Nicholas ◽

M.B. Zimmerman ◽

...

Keyword(s):

Tooth Extraction ◽

Alveolar Bone ◽

Controlled Trial ◽

Control Group ◽

Ridge Preservation ◽

Alveolar Ridge ◽

Bone Augmentation ◽

Randomized Controlled ◽

Implant Placement ◽

Alveolar Ridge Preservation

Alveolar ridge preservation (ARP) therapy is indicated to attenuate the physiologic resorptive events that occur as a consequence of tooth extraction with the purpose of facilitating tooth replacement therapy. This randomized controlled trial was primarily aimed at testing the efficacy of ARP as compared with unassisted socket healing. A secondary objective was to evaluate the effect that local phenotypic factors play in the volumetric reduction of the alveolar bone. A total of 53 subjects completed the study. Subjects were randomized into either the control group, which involved only tooth extraction (EXT n = 27), or the experimental group, which received ARP using a combination of socket grafting with a particulate bone allograft and socket sealing with a nonabsorbable membrane (dPTFE) following tooth extraction (ARP n = 26). A set of clinical, linear, volumetric, implant-related, and patient-reported outcomes were assessed during a 14-wk healing period. All linear bone assessments (horizontal, midbuccal, and midlingual reduction) revealed that ARP is superior to EXT. Likewise, volumetric bone resorption was significantly higher in the control group (mean ± SD: EXT = −15.83% ± 4.48%, ARP = −8.36% ± 3.81%, P < 0.0001). Linear regression analyses revealed that baseline buccal bone thickness is a strong predictor of alveolar bone resorption in both groups. Interestingly, no significant differences in terms of soft tissue contour change were observed between groups. Additional bone augmentation to facilitate implant placement in a prosthetically acceptable position was deemed necessary in 48.1% of the EXT sites and only 11.5% of the ARP sites ( P < 0.004). Assessment of perceived postoperative discomfort at each follow-up visit revealed a progressive decrease over time, which was comparable between groups. Although some extent of alveolar ridge remodeling occurred in both groups, ARP therapy was superior to EXT as it was more efficacious in the maintenance of alveolar bone and reduced the estimated need for additional bone augmentation at the time of implant placement (ClinicalTrials.gov NCT01794806).

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Primary Stability Optimization by Using Fixtures with Different Thread Depth According To Bone Density: A Clinical Prospective Study on Early Loaded Implants

Materials ◽

10.3390/ma12152398 ◽

2019 ◽

Vol 12 (15) ◽

pp. 2398 ◽

Cited By ~ 8

Author(s):

Christian Makary ◽

Abdallah Menhall ◽

Carole Zammarie ◽

Teresa Lombardi ◽

Seung Yeup Lee ◽

...

Keyword(s):

Bone Density ◽

Primary Stability ◽

Stability Loss ◽

Insertion Torque ◽

Implant Stability ◽

Marginal Bone Loss ◽

Early Loading ◽

Bone Level ◽

Implant Therapy ◽

Provisional Restoration

Background: Macro- and micro-geometry are among the factors influencing implant stability and potentially determining loading protocol. The purpose of this study was to test a protocol for early loading by controlling implant stability with the selection of fixtures with different thread depth according to the bone density of the implant site. Materials and Methods: Patients needing implant therapy for fixed prosthetic rehabilitation were treated by inserting fixtures with four different thread diameters, selected based on clinical assessment of bone quality at placement (D1, D2, D3, and D4, according to Misch classification). Final insertion torque (IT) and implant stability quotient (ISQ) were recorded at baseline and ISQ measurements repeated after one, two, three, and four weeks. At the three-week measurement (four weeks after implant replacement), implants with ISQ > 70 Ncm were functionally loaded with provisional restorations. Marginal bone level was radiographically measured 12 months after implant insertion. Results: Fourteen patients were treated with the insertion of forty implants: Among them, 39 implants showing ISQ > 70 after 3 weeks of healing were loaded with provisional restoration. Mean IT value was 82.3 ± 33.2 Ncm and varied between the four different types of bone (107.2 ± 35.6 Ncm, 74.7 ± 14.0 Ncm, 76.5 ± 31.1 Ncm, and 55.2 ± 22.6 Ncm in D1, D2, D3, and D4 bone, respectively). Results showed significant differences except between D2 and D3 bone types. Mean ISQ at baseline was 79.3 ± 4.3 and values in D1, D2, D3, and D4 bone were 81.9 ± 2.0, 81.1 ± 1.0, 78.3 ± 3.7, and 73.2 ± 4.9, respectively. Results showed significant differences except between D1 and D2 bone types. IT and ISQ showed a significant positive correlation when analyzing the entire sample (p = 0.0002) and D4 bone type (p = 0.0008). The correlation between IT and ISQ was not significant when considering D1, D2, and D3 types (p = 0.28; p = 0.31; p = 0.16, respectively). ISQ values showed a slight drop at three weeks for D1, D2, and D3 bone while remaining almost unchanged in D4 bone. At 12-month follow-up, all implants (39 early loading, 1 conventional loading) had satisfactory function, showing an average marginal bone loss of 0.12 ± 0.12 mm, when compared to baseline levels. Conclusion: Matching implant macro-geometry to bone density can lead to adequate implant stability both in hard and soft bone. High primary stability and limited implant stability loss during the first month of healing could allow the application of early loading protocols with predictable clinical outcomes.

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Immediate and Early Loading of Hydrothermally Treated, Hydroxyapatite-Coated Dental Implants: 2-Year Results from a Prospective Clinical Study

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-14-00283 ◽

2016 ◽

Vol 42 (1) ◽

pp. 17-25 ◽

Cited By ~ 3

Author(s):

David E. Simmons ◽

Archontia Palaiologou ◽

Austin G. Teitelbaum ◽

Susan Billiot ◽

Lomesh J. Popat ◽

...

Keyword(s):

Tactile Feedback ◽

Prospective Clinical Study ◽

Insertion Torque ◽

Implant Stability ◽

Implant Placement ◽

Early Loading ◽

Group A ◽

Bone Level ◽

Group B ◽

Plasma Sprayed

This investigation was undertaken to determine if multithreaded implants partially coated with plasma-sprayed hydroxyapatite (HA) could be effectively loaded earlier than 3–6 months after placement. Forty-eight patients (22 men, 26 women) were enrolled in the study and received 48 implants. The population was divided into 2 groups: A implants (n = 23) were loaded immediately on the day of surgery and group B implants (n = 19) were loaded 3 weeks after surgery. Cone beam computerized tomography (CBCT) scans were taken preoperatively to aid in treatment planning. Bone density was evaluated by tactile feedback during surgery. Insertion torque was recorded at time of implant placement. Resonance frequency analysis, performed on the day of surgery, at the time of loading, and at 6, 12, and 24 months, was used to record implant stability according to the unit's implant stability quotient (Osstell ISQ). Standardized radiographs were taken at time of implant placement and at 6, 12, and 24 months to measure crestal bone stability. Bone level changes were measured by software (Image J). Bone quality was judged as either type 1 (n = 1), 2 (n = 31), 3 (n = 15), or 4 (n = 1). There were no failures in the group A (survival = 100%, n = 23/23) and 1 failure in group B (survival = 94.7%, n = 18/19). After 2 years in function, cumulative mean radiographic bone loss was 0.75 ± 0.50mm (maxillae: 0.92 ± 0.49 mm, n = 14; mandibles: 0.67 ± 0.49 mm, n = 28). No differences in bone levels were noted between implants placed in previously augmented and nonaugmented sites, and there were no periodontal or soft tissue complications. After 2 years in function, implants partially coated with plasma-sprayed and hydrothermally treated HA were clinically predictable when restored in occlusion immediately after or within 3 weeks of implant placement.

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