Implant placement in the aesthetic zone: More efficiency in guided surgery

The aim of this case report is to describe the combining of a surgical guide with a temporary restoration to streamline the implant process. A 54-year-old male patient presenting partial edentulism underwent computer-aided template-guided implant placement for the replacement of the missing upper second right incisor. The presented technique was used during the surgical procedures; it introduced the integration of a surgical guide into the temporary fixed partial denture. Using computer-aided design, computer-aided manufacturing technology and virtual implant planning, a temporary-implantation fixed partial denture was constructed, and a guidance sleeve was implemented into it. The implant bed preparation was then performed using the bridge as a surgical guide. After osteotomy, the guidance sleeve within the bridge was sealed, and the bridge was temporarily incorporated for submerged healing of the implant. The usage of a temporary restoration as a surgical guide seems to make the digital workflow of guided implant placement more efficient, by achieving a representative clinical outcome.

The Assessment of the Maximum Heat Production and Cooling Effectiveness of Three Different Drill Types (Conical vs. Cylindrical vs. Horizontal) during Implant Bed Preparation—An In Vitro Study

The aim of this experimental study was to verify thermal diffusion differences, by measuring the maximum temperature achieved with different drill shapes. Synthetic bone blocks of type I density made from solid rigid polyurethane (PUR) foam were used to perform the drilling procedures. The experiment was conducted at three different rotation speeds: 800, 3000 and 5000 rpm. Conical drills (with and without an internal cooling hole) were compared with horizontal drills and disc drills. The temperature during drilling for implant bed preparation was estimated with the use of thermocouples and an infrared (IR) camera. The temperature during drilling with disc cutters for lateral basal implants did not exceed 33 ∘C and the temperature decreased in proportion to higher drill speed. The results indicate that the tested design is safe and will not cause bone overheating.

An immediate implant placement technique to rehabilitate multi-rooted teeth by pre-extraction interradicular implant bed preparation using remaining roots as a guide: A case presentation

The introduction of osseointegrated implants have revolutionized the art and science of modern dentistry giving a new lease of life to the restorative aspects in day-to-day practice. Immediate loading (IL) of dental implants can significantly decrease treatment time and thus increase patient acceptance. IL of dental implants has recently gained popularity due to several factors including reduced trauma as well as aesthetic and psychological benefits to the patient. The present case report describes the immediate replacement of partially edentulous maxilla using Nobel Active™ implant. It describes about the diagnosis, treatment planning and procedures involving the placement of single tooth immediate implant followed by uneventful healing.

Esthetic treatment of anterior implants: A case report

Aesthetic implant treatment in the maxillary anterior area can be challenging, especially in case of insufficient bone volume. In this clinical report, a guided bone regeneration procedure using the combination of xenograft and allograft with non-resorbable membrane was applied in the atrophic edentulous alveolar crest to reconstruct a proper implant bed. Moreover, Prosthetic tissue molding was performed to improve success and optimize aesthetics. This article provides information rele- vant to treatment plans, surgical procedures, and prosthetic management in aesthetically important areas.

Counterclockwise Drilling with Different Tapered Drills Condenses the Implant Bed—An Optical Coherence Tomography In Vitro Study

Background and Objectives: To evaluate the condensation and the microarchitecture of implant bed walls of sites prepared with counterclockwise drilling with tapered implant drills using optical coherence tomography. Materials and Methods: Four drill designs with different wall and tip angles were used. Polyurethane laminas resembling type IV bone microarchitecture were superimposed and clamped with a vice to simulate the coronal, middle, and apical aspects of the implant site. Twenty implant beds were prepared at 1200 rpm in clockwise (control) and counterclockwise (test) directions (N = 160). Optical coherence tomography (OCT) was used to evaluate the condensation and microarchitecture characteristics of the implant bed walls. The relative condensation was calculated using the Image J software Bone application. The microarchitecture was evaluated in reconstructed 3D volumes in XY, XZ, and YZ sections. Statistical analysis was performed using one-way ANOVA. Dunnet test was applied to determine differences between groups. Significance was set as p < 0.05. Results: Counterclockwise drilling (Test) condensed and changed the microarchitecture of the apical regions for all the implant beds in all of the groups when compared to clockwise drilling (control). The apical region of test groups showed the highest relative bone condensation (p = 0.026) when compared to controls. Conclusions: The direction of rotation (counterclockwise drilling) and not the design of tapered drills (tip and wall angles) is responsible for the condensation at the apical area observed in polyurethane blocks. The OCT method can be used for the evaluation of changes in density and microstructure of polyurethane blocks.

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

Primary 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.

Comparison of Implant Stability Between Conventional Drills and Piezosurgical Implant Bed Preparation Techniques

This prospective study compared the stability of implants placed using piezoelectric surgery (piezo group) and those placed using conventional rotary drills (bur group) during the first 90 days postoperatively. Teeth in the posterior maxillary regions of twenty-one patients were randomly assigned to two groups. The implant stability quotient (ISQ) was measured at days 0, 7, 14, 21, 28, 42, 56 and 90 postoperatively. Twenty eight out of 29 implants were successfully integrated at day 90 (one implant in the test group was lost). Although both groups showed a significant overall increase in implant stability with time (p&lt; 0.0001) and a high final mean ISQ value, no statistically significant difference in stability was seen between groups. The bur group showed greater variance in ISQ values than the piezo group (p&lt; 0.001) at all time points. Long-term studies with larger samples are needed to investigate the bone response to the use of piezoelectric surgery for implant preparation.

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

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.

Does the Modification of the Apical Geometry of a Dental Implant Affect Its Primary Stability? A Comparative Ex Vivo Study

(1) Background: Primary stability—one fundamental criterion for the success of dental implants—is influenced by implant geometry even if the effect of apical shape modifications on implant primary stability has not yet been examined. Therefore, the aim of the ex vivo study was to compare primary stability of implants differing in apically located screw threads (J-line) or a flat tip (K-line) only. (2) Methods: 28 implants of each group of the same diameter (4.3 mm) were randomly inserted into porcine bone blocks. The first group (9, 11 and 13 mm) was inserted into “hard”, the second (11 mm) into “soft” bone, here using a normal and an undersized drilling protocol. Insertion torque (Ncm), Periotest® value, resonance frequency (implant stability coefficient, ISQ) and push-out force (N) were measured. (3) Results: In “hard” bone, primary stability increased with increasing length in both groups but it was significantly higher in J-line (p < 0.03). An undersized preparation of the implant bed in “soft” bone resulted in a significant increase in primary stability in both groups. Here, J-line also showed a significantly increased primary stability when compared to equally prepared K-line (insertion torque: 37 Ncm vs. 26 Ncm; Periotest®: −6.5 vs. −4.3; push-out force: 365 N vs. 329 N; p < 0.05 each). (4) Conclusions: Primary stability is significantly higher with increasing implant length and apically located screw threads as well as with undersized drilling protocols. When preparing the implant site and subsequently selecting the implant system, modifying factors such as implant geometry (also at the tip) should be taken into account.