Does the Osseodensification Technique Allow for the use of a Healing Chamber with Primary Stability in Low-Density Bone? An in Vivo Study

Abstract This study aimed to investigate in vivo the hypothesis that the osseodensification technique, through a wider osteotomy, produce healing chambers at the implant-bone interface with no impact on primary stability osseointegration in low-density bone. Twenty implants (3.5 x 10 mm) presenting nanohydroxyapatite (nHA) surface were inserted in the ilium of ten sheep, after preparation of a 2.7-mm wide implant bed with conventional subtractive drilling (SCD) or a 3.8-mm wide implant bed with an osseodensification bur system (OBS) (n = 5/group/period). The final insertion torque (IT) and implant stability quotient (ISQ) evaluated the primary implant stability. After 14 and 28 days, the bone samples containing the implants were processed for histological and histomorphometric evaluation of bone implant contact (BIC) and bone area fraction occupancy (BAFO). No significant differences occurred between the implant bed preparations regarding IT and ISQ (P > 0.05). Histological analysis showed bone remodeling, and bone growth in all samples with no inflammatory infiltrate. BIC values were higher for SCD after 14 and 28 days (p < 0.05), however BAFO values were similar on both groups (p > 0.05). It was possible to conclude that the osseodensification technique allowed a wider implant bed preparation with no prejudice on primary stability and bone remodeling.

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Osseodensification enables bone healing chambers with improved low-density bone site primary stability: an in vivo study

Scientific Reports ◽

10.1038/s41598-021-94886-y ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Rafael Coutinho Mello-Machado ◽

Suelen Cristina Sartoretto ◽

Jose Mauro Granjeiro ◽

José de Albuquerque Calasans-Maia ◽

Marcelo Jose Pinheiro Guedes de Uzeda ◽

...

Keyword(s):

Primary Stability ◽

Group Differences ◽

Insertion Torque ◽

Low Density ◽

Implant Stability ◽

Significant Group ◽

Bone Implant ◽

Post Surgery ◽

Implant Bed

AbstractPrimary implant stability is a prerequisite for successful implant osseointegration. The osseodensification technique (OD) is a non-subtractive drilling technique that preserves the bone tissue, increases osteotomy wall density, and improves the primary stability. This study aimed to investigate the hypothesis that OD, through a wider osteotomy, produces healing chambers (HCs) at the implant-bone interface without impacting low-density bone primary stability. Twenty implants (3.5 × 10 mm) with a nanohydroxyapatite (nHA) surface were inserted in the ilium of ten sheep. Implant beds were prepared as follows: (i) 2.7-mm-wide using subtractive conventional drilling (SCD) technique (n = 10); (ii) 3.8-mm-wide using an OD bur system (n = 10). The sheep were randomized to two groups, with samples collected at either 14-(n = 5) or 28-days (n = 5) post-surgery and processed for histological and histomorphometric evaluation of bone-implant contact (BIC) and bone area fraction occupancy (BAFO). No significant group differences were found with respect to final insertion torque and implant stability quotient (p > 0.050). BIC values were higher for SCD after 14 and 28 days (p < 0.050); however, BAFO values were similar (p > 0.050). It was possible to conclude that the OD technique allowed a wider implant bed preparation without prejudice on primary stability and bone remodeling.

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Primary Stability of Dental Implants in Low-Density (10 and 20 pcf) Polyurethane Foam Blocks: Conical vs Cylindrical Implants

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17082617 ◽

2020 ◽

Vol 17 (8) ◽

pp. 2617 ◽

Cited By ~ 1

Author(s):

Luca Comuzzi ◽

Margherita Tumedei ◽

Ana Emilia Pontes ◽

Adriano Piattelli ◽

Giovanna Iezzi

Keyword(s):

Primary Stability ◽

Insertion Torque ◽

Low Density ◽

Implant Stability ◽

Implant Stability Quotient ◽

Pull Out ◽

Group A ◽

Group B ◽

Torque Values ◽

Clinical Conditions

Background: The aim of the present study was to compare, in low-density polyurethane blocks, the primary implant stability values (micromobility) and removal torque values of three different implant geometries in two different bone densities representing the structure of the human posterior jaws. Methods: A total of 60 implants were used in the present investigation: twenty implants for each of three groups (group A, group B, and group C), in both polyurethane 10 pcf and 20 pcf densities. The insertion torque, pull-out torque, and implant stability quotient (ISQ) values were obtained. Results: No differences were found in the values of Group A and Group B implants. In both these groups, the insertion torques were quite low in the 10 pcf blocks. Better results were found in the 20 pcf blocks, which showed very good stability of the implants. The pull-out values were slightly lower than the insertion torque values. High ISQ values were found in Group A and B implants. Lower values were present in Group C implants. Conclusions: The present investigation evaluated implants with different geometries that are available on the market, and not experimental implants specifically created for the study. The authors aimed to simulate real clinical conditions (poor-density bone or immediate post-extraction implants) in which knowledge of dental implant features, which may be useful in increasing the primary stability, may help the oral surgeon during the surgery planning.

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Effects of Different Undersizing Site Preparations on Implant Stability

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph17238965 ◽

2020 ◽

Vol 17 (23) ◽

pp. 8965

Author(s):

Bernardo Ferreira Lemos ◽

Paula Lopez-Jarana ◽

Carlos Falcao ◽

Blanca Ríos-Carrasco ◽

Javier Gil ◽

...

Keyword(s):

Primary Stability ◽

Immediate Loading ◽

Insertion Torque ◽

Bovine Bone ◽

Preparation Technique ◽

Standard Protocol ◽

Implant Stability ◽

Implant Stability Quotient ◽

Surgical Preparation ◽

Implant System

As immediate loading protocols are becoming more frequent, the primary stability of implants has become an essential criterion for the osseointegration of dental implants. Based on this, the objective of this study was to understand the influence of different undersized surgical preparation sites on the insertion torque (IT) and implant stability quotient (ISQ). Four different site-preparation protocols were performed on fresh humid type III bovine bone: one control, the standard protocol recommended by the manufacturer (P1), and three variations of undersized techniques (P2, P3 and P4). The implant used was VEGA by Klockner Implant System. The sample size was n = 40 for each of the four groups. A torquemeter was used to measure the IT, and the ISQ was measured with a Penguin RFA. Both variables showed a tendency to increase as the preparation technique was reduced, although not all the values were statistically significant (p < 0.05) when comparing with the standard preparation. The preparations without a cortical drill, P2 and P4, showed better results than those with a cortical drill. Given the limitations of this study, it can be concluded that reducing the implant preparation can increase both the IT and ISQ. Removing the cortical drill is an effective method for increasing implant stability, although it should be used carefully.

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Monitoring the Changes of Material Properties at Bone-Implant Interface during the Healing Process In Vivo: A Viscoelastic Investigation

BioMed Research International ◽

10.1155/2017/1945607 ◽

2017 ◽

Vol 2017 ◽

pp. 1-10

Author(s):

Hsiang-Ho Chen ◽

Wei-Yi Lai ◽

Tze-Jian Chee ◽

Ya-Hui Chan ◽

Sheng-Wei Feng

Keyword(s):

Viscoelastic Properties ◽

Healing Process ◽

Rabbit Model ◽

Resonance Frequency Analysis ◽

Implant Stability ◽

Stability Parameters ◽

Bone Implant ◽

Implant Stability Quotient ◽

The Mean

The aim of this study was to monitor the changes of viscoelastic properties at bone-implant interface via resonance frequency analysis (RFA) and the Periotest device during the healing process in an experimental rabbit model. Twenty-four dental implants were inserted into the femoral condyles of rabbits. The animals were sacrificed immediately after implant installation or on day 14, 28, or 56 after surgery. Viscoelastic properties at bone-implant interface were evaluated by measuring the implant stability quotient (ISQ) using RFA and by measuring the Periotest values (PTVs) using the Periotest device. The bone/implant specimens were evaluated histopathologically and histomorphometrically to determine the degree of osseointegration (BIC%). The BIC% values at different time points were then compared with the corresponding ISQ values and PTVs. The mean ISQ value increased gradually and reached 81±1.7 on day 56, whereas the mean PTV decreased over time, finally reaching −0.7±0.5 on day 56. Significant correlations were found between ISQ and BIC% (r=0.701, p<0.001), PTV and BIC% (r=-0.637, p<0.05), and ISQ and PTV (r=-0.68, p<0.05). These results show that there is a positive correlation between implant stability parameters and peri-implant-bone healing, indicating that the RFA and Periotest are useful for measuring changes of viscoelastic properties at bone-implant interface and are reliable for indirectly predicting the degree of osseointegration.

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Mechanical and Biological Advantages of a Tri-Oval Implant Design

Journal of Clinical Medicine ◽

10.3390/jcm8040427 ◽

2019 ◽

Vol 8 (4) ◽

pp. 427 ◽

Cited By ~ 1

Author(s):

Xing Yin ◽

Jingtao Li ◽

Waldemar Hoffmann ◽

Angelines Gasser ◽

John Brunski ◽

...

Keyword(s):

Bone Resorption ◽

High Strain ◽

Compressive Strain ◽

Primary Stability ◽

Implant Design ◽

Insertion Torque ◽

Implant Survival ◽

Implant Stability ◽

Over Time

Of all geometric shapes, a tri-oval one may be the strongest because of its capacity to bear large loads with neither rotation nor deformation. Here, we modified the external shape of a dental implant from circular to tri-oval, aiming to create a combination of high strain and low strain peri-implant environment that would ensure both primary implant stability and rapid osseointegration, respectively. Using in vivo mouse models, we tested the effects of this geometric alteration on implant survival and osseointegration over time. The maxima regions of tri-oval implants provided superior primary stability without increasing insertion torque. The minima regions of tri-oval implants presented low compressive strain and significantly less osteocyte apoptosis, which led to minimal bone resorption compared to the round implants. The rate of new bone accrual was also faster around the tri-oval implants. We further subjected both round and tri-oval implants to occlusal loading immediately after placement. In contrast to the round implants that exhibited a significant dip in stability that eventually led to their failure, the tri-oval implants maintained their stability throughout the osseointegration period. Collectively, these multiscale biomechanical analyses demonstrated the superior in vivo performance of the tri-oval implant design.

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Relation Between Insertion Torque and Implant Stability Quotient: A Clinical Study

European Journal of Dentistry ◽

10.1055/s-0041-1725575 ◽

2021 ◽

Author(s):

João Paulo do Vale Souza ◽

Clóvis Lamartine de Moraes Melo Neto ◽

Lucas Tavares Piacenza ◽

Emily Vivianne Freitas da Silva ◽

André Luiz de Melo Moreno ◽

...

Keyword(s):

Tooth Extraction ◽

Primary Stability ◽

Insertion Torque ◽

Resonance Frequency Analysis ◽

Implant Stability ◽

Significance Level ◽

Positive Correlation ◽

Implant Stability Quotient ◽

Implant Placement ◽

Secondary Stability

Abstract Objectives This study aimed to assess the relation between the insertion torque and implant stability quotient (ISQ recorded immediately and 6 months after implant placement). Materials and Methods Twenty-five patients over the age of 18 years were selected for this study. One implant was placed per patient after tooth extraction. The implant site needed 15 mm in height and 8 mm in width. All implants had the same size (11.5 × 3.75 mm) and brand (Hexagonal Morse cone, DSP Biomedical). The insertion torque (Ncm) and resonance frequency analysis (ISQ value) (Osstell Mentor) were used to assess the primary stability (on the day of surgery). After 6 months, ISQ value was used to assess the secondary stability of each implant. Statistical Analysis The insertion torque data were correlated with ISQ measurements by using Pearson’s correlation. The significance level was 5%. Results There was a positive correlation between insertion torque and initial ISQ (correlation: 0.457; p = 0.022); however, no correlation was found between insertion torque and final ISQ (p = 0.308). Conclusion The present study demonstrated that there is a positive correlation between the insertion torque and the initial ISQ. Therefore, the higher the insertion torque, the higher the initial ISQ (or vice versa).

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Primary Stability of Short Implants Inserted Using Piezoelectric or Drilling Systems: An In Vitro Comparison

Journal of Oral Implantology ◽

10.1563/aaid-joi-18-00157 ◽

2019 ◽

Vol 45 (4) ◽

pp. 259-266

Author(s):

Claudio Stacchi ◽

Matteo De Biasi ◽

Lucio Torelli ◽

Massimo Robiony ◽

Roberto Di Lenarda ◽

...

Keyword(s):

Cancellous Bone ◽

Operative Time ◽

Primary Stability ◽

Site Preparation ◽

Preparation Technique ◽

Implant Stability ◽

Implant Stability Quotient ◽

Custom Made ◽

Implant Site Preparation

The primary objective of the present in vitro study was to evaluate the influence of implant site preparation technique (drills vs ultrasonic instrumentation) on the primary stability of short dental implants with two different designs inserted in simulated low-quality cancellous bone. Eighty implant sites were prepared in custom-made solid rigid polyurethane blocks with two different low cancellous bone densities (5 or 15 pounds per cubic foot [PCF]), equally distributed between piezoelectric (Surgysonic Moto, Esacrom, Italy) and conventional drilling techniques. Two short implant systems (Prama and Syra, Sweden & Martina) were tested by inserting 40 fixtures of each system (both 6.0 mm length and 5.0 mm diameter), divided in the four subgroups (drills/5 PCF density; drills/15 PCF density; piezo/5 PCF density; piezo/15 PCF density). Insertion torque (Ncm), implant stability quotient values, removal torque (Ncm), and surgical time were recorded. Data were analyzed by 3-way ANOVA and Scheffé's test (α = 0.05). With slight variations among the considered dependent variables, overall high primary implant stability was observed across all subgroups. Piezoelectric instrumentation allowed for comparable or slightly superior primary stability in comparison with the drilling procedures in both implant systems. The Prama implants group showed the highest mean reverse torque and Syra implants the highest implant stability quotient values. Piezoelectric implant site preparation took prolonged operative time compared to conventional preparation with drills; among the drilling procedures, Syra system required fewer surgical steps and shorter operative time.

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Analysis of correlation between hounsfield units of CBCT scans and implant primary stability in implant stability quotient (ISQ)

Clinical Oral Implants Research ◽

10.1111/clr.182_13358 ◽

2018 ◽

Vol 29 ◽

pp. 297-297

Author(s):

Alexandre Campos Montenegro ◽

Mario Vieira Neto ◽

Gonçalo Pimentel Neto ◽

Silvana Pizzini Montenegro ◽

Kamila Temponi ◽

...

Keyword(s):

Primary Stability ◽

Implant Stability ◽

Hounsfield Units ◽

Implant Stability Quotient

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Developing Stability of Posterior Mandibular Implants Placed With Osteotome Expansion Technique Compared With Conventional Drilling Techniques

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-16-00101 ◽

2017 ◽

Vol 43 (2) ◽

pp. 131-138 ◽

Cited By ~ 1

Author(s):

Yen-Ting Lin ◽

Adrienne Hong ◽

Ying-Chin Peng ◽

Hsiang-Hsi Hong

Keyword(s):

Bone Density ◽

Surgical Techniques ◽

Primary Stability ◽

Conventional Technique ◽

Implant Stability ◽

Implant Stability Quotient ◽

Expansion Technique ◽

The Stability ◽

Conventional Drilling ◽

Secondary Stability

Clinical decisions regarding the stability and osseointegration of mandibular implants positioned using the bone expansion techniques are conflicting and limited. The objective was to evaluate the stability of implants placed using 2 surgical techniques, selected according to the initial width of the mandibular posterior edentulous ridge, with D3 bone density, during a 12-week period. Fifty-eight implants in 33 patients were evaluated. Thirty-two implants in 24 patients were positioned using the osteotome expansion technique, and 26 fixtures in 17 patients were installed using the conventional drilling technique. The implant stability quotient values were recorded at weeks 0, 1, 2, 3, 4, 6, 8, 10, and 12 postsurgery and evaluated using analysis of variance, independent, and paired t tests. Calibrated according to the stability reading of a 3.3-mm diameter implant, the osteotome expansion group was associated with a lower bone density than the conventional group (64.96 ± 6.25 vs 68.98 ± 5.06, P = .011). The osteotome expansion group achieved a comparable primary stability (ISQb-0, P = .124) and greater increases in secondary stability (ISQb-12, P = .07) than did the conventional technique. A D3 quality ridge with mild horizontal deficiency is expandable by using the osteotome expansion technique. Although the 2 groups presented similar implant stability quotient readings during the study period, the osteotome expansion technique showed significant improvement in secondary stability. The healing patterns for these techniques are therefore inconsistent.

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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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