The Influence of the Implant Macrogeometry on Insertion Torque, Removal Torque, and Periotest Implant Primary Stability: A Mechanical Simulation on High-Density Artificial Bone

Background: The primary stability is a determinant clinical condition for the success of different dental implants macro-design in different bone density using a validated and repeatable in vitro technique employing solid rigid polyurethane blocks. Materials and Methods: Five implants 3.8 × 13 mm2 for each macro-design (i.e., IK—tapered; IC—cylindric; and IA—active blade shape) were positioned into 20- and 30- pounds per cubic foot (PCF) polyurethane blocks. Bucco-lingual (BL) and mesial-distal (MD) implant stability quotient score (ISQ) was assessed by resonance frequency analysis while, insertion/removal torques were evaluated by dynamometric ratchet. Results: IC implants shown better primary stability in terms of ISQ compared to IA and IK in lower density block (20 PCF), while IK was superior to IA in higher density (30 PCF). IC shown higher removal torque in 30-PCF compared to IA and IC. Conclusions: The study effectiveness on polyurethane artificial bone with isotropic symmetry structure showed that the implants macro-design might represent a key factor on primary stability, in particular on low-density alveolar bone. Clinicians should consider patients features and implant geometry during low-density jaws rehabilitation. Further investigations are needed to generalize these findings.

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An In Vitro Analysis on Polyurethane Foam Blocks of the Insertion Torque (IT) Values, Removal Torque Values (RTVs), and Resonance Frequency Analysis (RFA) Values in Tapered and Cylindrical Implants

International Journal of Environmental Research and Public Health ◽

10.3390/ijerph18179238 ◽

2021 ◽

Vol 18 (17) ◽

pp. 9238

Author(s):

Luca Comuzzi ◽

Margherita Tumedei ◽

Camillo D’Arcangelo ◽

Adriano Piattelli ◽

Giovanna Iezzi

Keyword(s):

Dental Implants ◽

Frequency Analysis ◽

Primary Stability ◽

Cortical Layer ◽

Insertion Torque ◽

Low Density ◽

Resonance Frequency Analysis ◽

Removal Torque ◽

Torque Values

Background: Several different dental implant microgeometries have been investigated in the literature for use in low-density bone sites. The polyurethane solid rigid blocks represent an optimal in vitro study model for dental implants, because their composition is characterized by symmetrical linear chains of monomers of hexa-methylene sequences producing a self-polymerization process. The aim of the present investigation was to evaluate the primary stability of cylindrical and tapered implants positioned into low-density polyurethane solid rigid blocks. Materials and Methods: Two different macrogeometries, cylindrical (4 mm diameter and 10 mm length) and tapered dental implants (4.20 mm diameter and 10 mm length), were investigated in the present study. The implants were inserted into 10 PCF and 20 PCF polyurethane blocks, with and without an additional cortical layer. The insertion torque (IT) values, the removal torque values (RTVs), and the resonance frequency analysis (RFA) values were measured and recorded. Results: A total of 80 sites were tested, and a significant increased primary stability (PS) was detected in favour of tapered dental implants when compared to cylindrical implants in all experimental conditions (p < 0.05). Higher IT, RT, and RFA values were measured in tapered implants in 10 and 20 PCF polyurethane blocks, both with and without the additional cortical layer. Conclusions: Both implants showed sufficient primary stability in poor density substrates, while, on the other hand, the tapered microgeometry showed characteristics that could also lead to clinical application in low-density posterior maxillary sites, even with a drastically decreased bone cortical component.

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Comparison of Osteotome and Conventional Drilling Techniques for Primary Implant Stability: An In Vitro Study

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-15-00176 ◽

2016 ◽

Vol 42 (4) ◽

pp. 321-325 ◽

Cited By ~ 5

Author(s):

Ioanna N Tsolaki ◽

Pallavi P Tonsekar ◽

Babak Najafi ◽

Howard J Drew ◽

Andrew J Sullivan ◽

...

Keyword(s):

Pearson Correlation ◽

In Vitro Study ◽

Primary Stability ◽

Poor Quality ◽

Vitro Study ◽

Insertion Torque ◽

Low Density ◽

Posterior Maxilla ◽

Conventional Drilling

It may be difficult to achieve primary stability in the posterior maxilla because of poor quality and quantity of bone. Studies have shown that the osteotome technique immediately increases bone density thereby increasing primary stability. An in vitro study was conducted to compare the stability achieved by the osteotome and conventional drilling techniques in low density bone. Forty endosseous implant fixtures (n = 40) were inserted in a solid rigid polyurethane block simulating low density (D3) bone. The implants were divided into 4 groups to test 2 variables: (1) implant length (10 mm or 13 mm) and (2) preparation of osteotomy (conventional drilling or osteotome technique). Insertion torque (IT) and resonance frequency analysis (RFA) were measured for each implant. Statistical analysis using one-way ANOVA and Tukey post hoc test was done to study IT and RFA data of the 4 groups. Pearson Correlation test was used to determine the correlation between IT and RFA values of the implants. The IT and RFA values were statistically significant higher using the osteotome technique as compared to conventional drilling (P < 0.0001). Statistically significant higher values were also found for IT and RFA of 13 mm implants as compared to 10 mm implants. A significant correlation was found between insertion torque and RFA values in all 4 groups (r = 0.86, P < 0.0001). The conclusion was that the osteotome technique significantly increased primary stability.

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Influence of Bone Quality, Drilling Protocol, Implant Diameter/Length on Primary Stability: An In Vitro Comparative Study on Insertion Torque and Resonance Frequency Analysis

Journal of Oral Implantology ◽

10.1563/aaid-joi-d-19-00145 ◽

2020 ◽

Vol 46 (3) ◽

pp. 182-189 ◽

Cited By ~ 1

Author(s):

Davide Farronato ◽

Mattia Manfredini ◽

Michele Stocchero ◽

Mattia Caccia ◽

Lorenzo Azzi ◽

...

Keyword(s):

Resonance Frequency ◽

Bone Quality ◽

Frequency Analysis ◽

Primary Stability ◽

Mean Difference ◽

Insertion Torque ◽

Resonance Frequency Analysis ◽

Bone Response ◽

Implant Length

The aim of this study was to evaluate the influence of bone quality, drilling technique, implant diameter, and implant length on insertion torque (IT) and resonance frequency analysis (RFA) of a prototype-tapered implant with knife-edge threads. The investigators hypothesized that IT would be affected by variations in bone quality and drilling protocol, whereas RFA would be less influenced by such variables. The investigators implemented an in vitro experiment in which a prototype implant was inserted with different testing conditions into rigid polyurethane foam blocks. The independent variables were: bone quality, drilling protocol, implant diameter, and implant length. Group A implants were inserted with a conventional drilling protocol, whereas Group B implants were inserted with an undersized drilling protocol. Values of IT and RFA were measured at implant installation. IT and RFA values were significantly correlated (Pearson correlation coefficient: 0.54). A multivariable analysis showed a strong model. Higher IT values were associated with drilling protocol B vs A (mean difference: 71.7 Ncm), implant length (3.6 Ncm increase per mm in length), and substrate density (0.199 Ncm increase per mg/cm3 in density). Higher RFA values were associated with drilling protocol B vs A (mean difference: 3.9), implant length (1.0 increase per mm in length), and substrate density (0.032 increase per mg/cm3 in density). Implant diameter was not associated with RFA or IT. Within the limitations of an in vitro study, the results of this study suggest that the studied implant can achieve good level of primary stability in terms of IT and RFA. A strong correlation was found between values of IT and RFA. Both parameters are influenced by the drilling protocol, implant length, and substrate density. Further studies are required to investigate the clinical response in primary stability and marginal bone response.

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Comparative In Vitro Evaluation of the Primary Stability in D3 Synthetic Bone of Two Different Shapes and Pitches of the Implant Threads

Applied Sciences ◽

10.3390/app11125612 ◽

2021 ◽

Vol 11 (12) ◽

pp. 5612

Author(s):

Stefano Fanali ◽

Margherita Tumedei ◽

Pamela Pignatelli ◽

Alessandra Lucchese ◽

Francesco Inchingolo ◽

...

Keyword(s):

Surgical Techniques ◽

Primary Stability ◽

Implant Design ◽

Insertion Torque ◽

Synthetic Bone ◽

One Stage ◽

Prosthetic Joint ◽

Joint Connection ◽

The One

Background: Implant primary stability can be affected by several factors related to implant macrogeometry, local anatomy, and surgical techniques. The aim of this research was to study primary stability on polyurethane foam sheets of wide-threaded implant design compared to narrow-threaded implants. Materials and methods: Two different implant designs were positioned on D3 density polyurethane blocks in a standardized environment: the wide-threaded implant and the narrow-threaded implant, for a total of 160 specimens. Moreover, for each group, two different sizes were considered: 3.8mm × 12mm and 4.8mm × 12 mm. The insertion torque (IT) values, the removal strength (RT), and the Periotest analyses were evaluated. Results: A significantly higher IT and RT was reported for wide-threaded implants and two-stage implants (p < 0.01), compared to the narrow-threaded implants. The diameters seemed to provide a significant effect on the primary stability for both implants’ geometry (p < 0.01). A higher mean of the one-stage implant was evident in the Periotest measurements (p < 0.01). Conclusions: Both of the implants showed sufficient stability in polyurethane artificial simulation, while the wide-threaded implant design showed a higher primary stability on alveolar cancellous synthetic bone in vitro. Additionally, the prosthetic joint connection seemed to have a determinant effect on Periotest analysis, and the one-stage implants seemed to provide a high stability of the fixture when positioned in the osteotomy, which could be important for the immediate loading protocol.

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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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Osseodensification Drilling vs. Standard Protocol of Implant Site Preparation: An In Vitro Study on Polyurethane Foam Sheets

Prosthesis ◽

10.3390/prosthesis2020008 ◽

2020 ◽

Vol 2 (2) ◽

pp. 76-86

Author(s):

Luca Comuzzi ◽

Margherita Tumedei ◽

Adriano Piattelli ◽

Giovanna Iezzi

Keyword(s):

Polyurethane Foam ◽

Cortical Layer ◽

Polyurethane Foams ◽

Insertion Torque ◽

Standard Type ◽

Removal Torque ◽

In Vitro Investigation ◽

Posterior Maxilla ◽

And Control

(1) Background: The aim of the present in vitro investigation was to evaluate, on polyurethane sheets, two different drilling techniques for dental implant positioning using osteocondensing burs compared to a standard type protocol. (2) Methods: Three different implant designs (Implacil De Bortoli UN III 4 × 10 mm, Restore RBM 4 (HEX) × 10 mm; Implacil De Bortoli UN II 4 × 10 mm) were evaluated (test implant (osteocondensing drills) and control implant (standard drills)). The insertion torque (IT), the removal torque (RT) and the resonance frequency analysis (RFA) values of test and control implants inserted in different size and different density polyurethane foam models were compared for 120 experimental sites. Accordingly, 120 experimental holes were produced in different PCF polyurethane foams: 60 sites were produced in 10 PCF sheets and 60 sites in 10 PCF sheets with an additional 1 mm layer of 30 PCF. (3) Results: The IT, removal torque and RFA values were significantly higher for both of the evaluated implants, in the sites prepared with the osteocondenser drills when compared to sites prepared with standard drills (p < 0.05). The UNII and UN III showed significantly higher stability compared to the HEX implant; these differences increased drastically in the 10 PCF Polyurethane Block with the additional 1 mm cortical layer (p < 0.05). (4) Conclusions: The outcome of this investigation suggested a possible clinical application of osteocondensing burs in case of reduced bone quality and quantity in the posterior maxilla.

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Effects of Intrabony Length and Cortical Bone Density on the Primary Stability of Orthodontic Miniscrews

Materials ◽

10.3390/ma13245615 ◽

2020 ◽

Vol 13 (24) ◽

pp. 5615

Author(s):

Jie Jin ◽

Gi-Tae Kim ◽

Jae-Sung Kwon ◽

Sung-Hwan Choi

Keyword(s):

Bone Density ◽

Cortical Bone ◽

Primary Stability ◽

Insertion Torque ◽

Low Density ◽

Horizontal Resistance ◽

Cortical Bone Density ◽

Temporary Anchorage Devices ◽

Implantation Depth ◽

Maximum Removal

Miniscrews have gained recent popularity as temporary anchorage devices in orthodontic treatments, where failure due to sinus perforations or damage to the neighboring roots have increased. Issues regarding miniscrews in insufficient interradicular space must also be resolved. This study aimed to evaluate the primary stability of miniscrews shorter than 6 mm and their feasibility in artificial bone with densities of 30, 40, and 50 pounds per cubic foot (pcf). The primary stability was evaluated by adjusting the intrabony miniscrew length, based on several physical properties: maximum insertion torque (MIT), maximum removal torque (MRT), removal angular momentum (RAM), horizontal resistance, and micromotion. The MIT and micromotion results demonstrated that the intrabony length of a miniscrew significantly affected its stability in low-density cortical bone, unlike cases with a higher cortical bone density (p < 0.05). The horizontal resistance, MRT, and RAM were affected by the intrabony length, regardless of the bone density (p < 0.05). Thus, the primary stability of miniscrews was affected by both the cortical bone density and intrabony length. The effect of the intrabony length was more significant in low-density cortical bone, where the implantation depth increased as more energy was required to remove the miniscrew. This facilitated higher resistance and a lower risk of falling out.

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An in vitro evaluation on polyurethane foam sheets of the insertion torque, removal torque values, and resonance frequency analysis (RFA) of a self-tapping threads and round apex implant

Cellular Polymers ◽

10.1177/0262489320971796 ◽

2020 ◽

pp. 026248932097179

Author(s):

Margherita Tumedei ◽

Adriano Piattelli ◽

Antonello Falco ◽

Francesco De Angelis ◽

Felice Lorusso ◽

...

Keyword(s):

Resonance Frequency ◽

Dental Implant ◽

Frequency Analysis ◽

Insertion Torque ◽

Resonance Frequency Analysis ◽

Removal Torque ◽

In Vitro Investigation ◽

Posterior Maxilla ◽

Torque Values

The dental implant primary stability and micromovement absence represent critical factor for dental implant osseointegration. The aim of the present in vitro investigation was to simulate the bone response on different polyurethane densities the effect of self-tapping threads and round apex implant geometry. A total of 40 implants were positioned in D1, D2, D3 and D4 polyurethane block densities following a calibrated drilling protocol. The Insertion, removal Torque and resonance frequency analysis (RFA) means were calculated. All experimental conditions showed insertion torque values >30 Ncm. A significant higher insertion torque, removal and RFA was present in D1 polyurethane. Similar evidences were evidenced for D3 and D4. The effectiveness of the present study suggested a valuable clinical advantage for self-tapping threads and round apex implant using, such as in case of reduced bone density in the posterior maxilla

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Influence of Orthodontic Anchor Screw Anchorage Method on the Stability of Artificial Bone: An In Vitro Study

Materials ◽

10.3390/ma13143205 ◽

2020 ◽

Vol 13 (14) ◽

pp. 3205 ◽

Cited By ~ 2

Author(s):

Seen-Young Kang ◽

Ji-Min Yu ◽

Hyoung-Sik Kim ◽

Jun-Seok Lee ◽

Chan-Mi Yeon ◽

...

Keyword(s):

In Vitro Study ◽

Automatic Device ◽

Insertion Torque ◽

Artificial Bone ◽

Artificial Bones ◽

Significant Difference ◽

The Mean ◽

The Stability ◽

Torque Values

This study aims to compare the torque values for various lengths of the titanium-based orthodontic anchor screw (OAS), different anchorage methods and varying artificial bone densities after predrilling. Furthermore, the effects of these parameters on bone stability are evaluated. A total of 144 OASs were prepared with a diameter of 1.6 mm and heights of 6, 8 and 10 mm. Artificial bones were selected according to their density, corresponding to Grades 50, 40 and 30. Torque values for the automatic device and manual anchorage methods exhibited a statistically significant difference for the same-sized OAS, according to the bone density of the artificial bones (p < 0.05). However, when insertion torque was at the maximum rotations, there was no significant difference in the torque values for the Grade 30 artificial bone (p > 0.05). When the torque values of both anchorage methods were statistically compared with the mean difference for each group, the results of the manual anchorage method were significantly higher than those of the automatic device anchorage method (p < 0.05). A statistically significant difference was observed in the bone stability resulting from different OAS anchorage methods and artificial bone lengths. These findings suggest that the automatic anchorage method should be used when fixing the OAS.

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

10.21203/rs.3.rs-462910/v1 ◽

2021 ◽

Author(s):

Rafael Coutinho Mello-Machado ◽

Suelen Cristina Sartoretto ◽

Jose Mauro Granjeiro ◽

José Albuquerque Calasans-Maia ◽

Marcelo Jose Guedes Pinheiro Uzeda ◽

...

Keyword(s):

Bone Remodeling ◽

Bone Growth ◽

Primary Stability ◽

Insertion Torque ◽

Low Density ◽

Implant Stability ◽

Bone Implant ◽

Implant Stability Quotient ◽

Implant Bed

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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