Predicting osseointegration by means of implant primary stability

Clinical Assessment of Dental Implant Stability During Follow-Up: What Is Actually Measured, and Perspectives

The optimization of loading protocols following dental implant insertion requires setting up patient-specific protocols, customized according to the actual implant osseointegration, measured through quantitative, objective methods. Various devices for the assessment of implant stability as an indirect measure of implant osseointegration have been developed. They are analyzed here, introducing the respective physical models, outlining major advantages and critical aspects, and reporting their clinical performance. A careful discussion of underlying hypotheses is finally reported, as is a suggestion for further development of instrumentation and signal analysis.

Immediately placed dental implants in smokers with plasma rich in growth factor versus without plasma rich in growth factor: A comparison

Introduction:

The placement of implants into fresh extraction sockets was introduced in 1970. This approach has been reviewed extensively during the past decade. Immediate postextraction implant placement is a well-accepted protocol. The concept of placement of dental implants soon after the removal of a tooth in smokers, however, is still a matter of controversy.

Purpose:

(i) To access failure rate of dental implant in smokers (ii) To evaluate added advantage of plasma rich in growth factors (PRGFs) in immediate placement of dental implants in smokers.

Materials and Methods:

The sample of 30 patients was obtained from the different Outpatient Department of Faculty of Dental Sciences; King George's Medical University, Lucknow, who had visited for rehabilitation of missing teeth by implants between April 2013 and July 2015. They were randomly divided into two groups (without use of PRGF and with use of PRGF) of 15 each. Pre- and postoperative assessment included a thorough history and clinical examination, regression of pain and swelling, implant stability by resonance frequency analysis (RFA), and implant stability according to the bone type as well as radiographic interpretation for measurement of bone loss on the mesial and distal surfaces of the implant.

Results:

In this study, pain and swelling were significantly (P < 0.05) higher in Group A than in Group B across the time interval. RFA score for implant stability was lower in Group A across the period than Group B. At the end of 3 months, RFA score (mean) in Group A was having 72.55 ISQ value, and in Group B, it was 75.71 ISQ value. In this study, postoperative crestal bone loss was more in patients in Group A as compared to patients in Group B. There was significant difference in mesial (P = 0.003) and distal (P = 0.001) crestal bone loss at 6 months between the groups.

Conclusion:

The immediate placement of dental implants in smokers with use of PRGF is shown to be efficient in relation to postoperative pain and swelling, stability, stability according to bone type, as well as bone loss.

Bone Texture Fractal Dimension Analysis of Ultrasound-Treated Bone around Implant Site: A Double-Blind Clinical Trial

Objectives

To evaluate the efficacy of bone texture fractal dimension (FD) analysis method in predicting implant stability from intraoral periapical radiographs using two implant protocols.

Materials and Methods

A double-blind clinical trial was conducted on 22 subjects who needed dental implants. The participants were randomized into two groups, the control group with standard implant protocol treatment and the intervention group with added low-intensity power ultrasound treatment (LIPUS) besides the standard implant protocol. The FD values of bone density were carried out on the mesial and distal sides of the implant on digital intraoral radiographs using the box-counting method. Both resonance frequency (RF) and fractal dimension (FD) were assessed in three time intervals: after surgery and before and after loading.

Results

FD on both the mesial and distal sides serve as very good-to-excellent tests with high validity (ROC area exceeding 0.8) in predicting high implant stability (ISQ ≥ 70). The mesial side measurements were consistently better than the distal side among the intervention groups. The optimum cutoff value for the FD-mesial side that predicts a highly stable implant (ISQ ≥ 70) is ≥1.505. At this optimum cutoff value, the mesial side FD is associated with a perfect sensitivity (100%) and fairly high specificity (86.5%).

Conclusion

The FD analysis could be recommended as an adjunctive quantitative method in prediction of the implant stability with very high sensitivity and specificity. This trial is registered with ISRCTN72648040.

Stability of tapered and parallel-walled dental implants: A systematic review and meta-analysis

BACKGROUND

Clinical trials have suggested that dental implants with a tapered configuration have improved stability at placement, allowing immediate placement and/or loading. The aim of this systematic review and meta-analysis was to evaluate the implant stability of tapered dental implants compared to standard parallel-walled dental implants.

MATERIALS AND METHODS

Applying the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) statement, randomized controlled trials (RCTs) were searched for in electronic databases and complemented by hand searching. The risk of bias was assessed using the Cochrane Collaboration's Risk of Bias tool and data were analyzed using statistical software.

RESULTS

A total of 1199 studies were identified, of which, five trials were included with 336 dental implants in 303 participants. Overall meta-analysis showed that tapered dental implants had higher implant stability values than parallel-walled dental implants at insertion and 8 weeks but the difference was not statistically significant. Tapered dental implants had significantly less marginal bone loss compared to parallel-walled dental implants. No significant differences in implant failure rate were found between tapered and parallel-walled dental implants.

CONCLUSIONS

There is limited evidence to demonstrate the effectiveness of tapered dental implants in achieving greater implant stability compared to parallel-walled dental implants. Superior short-term results in maintaining peri-implant marginal bone with tapered dental implants are possible. Further properly designed RCTs are required to endorse the supposed advantages of tapered dental implants in immediate loading protocol and other complex clinical scenarios.

Effect of implant macrogeometry on peri-implant healing outcomes: a randomized clinical trial

OBJECTIVES

This randomized split-mouth clinical trial investigated the influence of implant macrogeometry on bone properties and peri-implant health parameters during the healing process.

MATERIAL AND METHODS

Ninety-nine implants were placed bilaterally in posterior mandibles of 23 patients that received at least four dental implant macrogeometries: standard geometry, Integra (IN) and three geometries inducing "healing chamber": Duo (D), Compact (C), and Infra (IF). Insertion torque (IT) and implant stability quotient (ISQ) were measured. Peri-implant health were monitored by visible plaque index (VPI), peri-implant inflammation (PI), and presence of calculus (CC). Data were collected during 90 days. Data were assessed for normality using the asymmetry and kurtosis coefficients followed by the Shapiro-Wilk test. A one-way ANOVA was used to investigate differences in IT and linear bone dimensions between the macrogeometry groups. The repeated measurements ANOVA test or ANOVA-R was used for analysis of ISQ, VPI, and PI. Tukey-Kramer test or Student's t test was used for comparisons between the groups or within each macrogeometry.

RESULTS

Macrogeometry did not significantly influence IT and ISQ values. The minimum ISQ was recorded after 7 days (71.95 ± 12.04, p = 0.0001). Intermediate ISQ was found after 14 days, when the ISQ reached values that are statistically identical to primary stability. The VPI showed significantly higher scores for the D (0.88 ± 1.03) and IN (0.72 ± 0.94) implants after 7 days. The PI was only influenced by the healing time significantly decreasing from 7 (1.07 ± 0.89) to 21 days (0.18 ± 0.18).

CONCLUSION

Implant macrogeometry did not influence IT nor ISQ values. The relationship between IT and SS was more evident for the Duo implant, but only in the final stage of healing process.

CLINICAL RELEVANCE

Show to the clinician that the macrogeometry and drilling protocols did not interfere in the clinical behavior of the implants during the healing process. However, the IT, primary and secondary stability, is quite dependent of the surgeon experience.

Prospective multicenter non-randomized controlled study on intraosseous stability and healing period for dental implants in the posterior region

Background

A current implant body surface was treated with “rough processing” by sandblasting and acid etching for the purposes of obtaining more reliable osseointegration and shortening the treatment period. Various reports have examined the healing period with the use of these implant bodies, but a consensus opinion has not yet been obtained. The purpose of this study is to evaluate the relationship between insertion torque (IT) and implant stability quotient (ISQ) at implant treatment using the current rough-surfaced implant. We evaluated the implant treatment sites with ISQ values, IT values, and voxel values.

Methods

Participants in this study comprised 26 patients (10 males, 16 females; mean age, 55.5 years) who received posterior region dental implants at Tokyo Dental College Hospital or Fukuoka Dental College Hospital. For all participants, pretreatment computed tomography and determination of bone quality from voxel values were performed. Thirty-two implant bodies were inserted into the posterior region, and insertion torque was measured. ISQ was also measured at 0, 2, 4, 6, 8, and 12 weeks postoperatively.

Results

Eight implant bodies in the maxilla and 24 in the mandible were inserted. All ISQ values increased, exceeding 60 by 6 weeks postoperatively. For insertion torque < 30 N cm, ISQ increased significantly after 8 weeks. For ≥ 30 N cm, the ratio at which high ISQ values appeared increased significantly after 6 weeks. Compared with the treatment area with insertion torque < 40 N cm, the treatment area ≥ 40 N cm showed a significantly higher voxel value.

Conclusions

No significant relationship was found between the insertion torque value and the ISQ value. Also, it was suggested that the ISQ value was considered to be an important indicator for observing the treatment state of the implant.

Conventional Drilling Versus Piezosurgery for Implant Site Preparation: A Meta-Analysis

The aim of this study was to evaluate if the stability of dental implants varies between dental implants placed by piezosurgery compared with those placed by conventional drilling. An electronic search in MEDLINE, SCOPUS, and the Cochrane Library was undertaken until August 2016 and was supplemented by manual searches and by unpublished studies at OpenGray. Only randomized controlled clinical trials that reported implant site preparation with piezosurgery and with conventional drilling were considered eligible for inclusion in this review. Meta-analyses were performed to evaluate the impact of piezosurgery on implant stability. Of 456 references electronically retrieved, 3 were included in the qualitative analysis and quantitative synthesis. The pooled estimates suggest that there is no significant difference between piezosurgery and conventional drilling at baseline (weighted mean differences [WMD]: 2.20; 95% confidence interval [CI]: -5.09, 9.49; P = .55). At 90 days, the pooled estimates revealed a statistically significant difference (WMD: 3.63; 95% CI: 0.58, 6.67, P = .02) favoring piezosurgery. Implant stability may be slightly improved when osteotomy is performed by a piezoelectric device. More randomized controlled clinical trials are needed to confirm these findings.

Evaluation of the effects of different sand particles that used in dental implant roughened for osseointegration

BACKGROUND

Successful dental implant treatment is directly related to osseointegration. In achieving osseointegration, the surface property of the implant is of great importance. Sandblasting is the most commonly used basic method for modifying the surface. Many companies use different sand particles for surface roughening and claim their sand is the best. This leads clinicians to mix their minds in product selection. In this study, we tried to find the appropriate sand material by working objectively without praising any brand. We believe that the results of the study will help clinicians choose the right dental implant. In this study, machined-surfaced implants and implants sandblasted with Aluminum oxide (Al₂O₃), Titanium dioxide (TiO₂) and Silicon dioxide (SiO₂) were compared via biomechanical testing.

METHODS

For the study, four 2 year-old sheep, weighing 45 kilograms (kg), were used. Eight implants (Al₂O₃, TiO₂, and SiO₂ sandblasted implants and machined-surfaced implants), each with different surface characteristics, were inserted into the bilateral tibia of each sheep under general anesthesia. Results of the initial Resonance Frequency Analysis (RFA) were recorded just after implant insertion. The sheep were then randomly divided into two groups, each with 2 sheep, to undergo either a 1-month or a 3-month assessment. At the end of the designated evaluation period, RFA and removal torque tests were performed.

RESULTS

Although there were no statistically significant differences between the groups, the implants sandblasted with Al₂O₃ showed a higher Implant Stability Quotient (ISQ) and removal torque value at the end of the 1st and 3rd month.

CONCLUSIONS

In short, the results of the study demonstrate that Aluminum oxide is superior to other sand particles.

Assessment of Dental Implant Stability in Areas Previously Submitted to Maxillary Sinus Elevation

This study aimed to compare the primary and secondary stability, measured by resonance frequency analysis (RFA), in implants of different lengths installed in areas submitted to maxillary sinus lift. Correlation between RFA and implant insertion torque was also assessed. Twenty implants of 9 and 11 mm were inserted in areas submitted to maxillary sinus lift. The insertion torque was measured by the Bien Air motor. Osstell, through RFA, determined the implant stability quotient (ISQ) 2 times: the day of implant installation (T1) and 90 days after implant installation (T2). No differences were observed in the ISQ between T1 and T2 when the 20 implants were grouped, nor when the 9 mm implants were evaluated separately. In contrast, when the 11 mm values were evaluated separately, the ISQ was significantly higher in T2 than in T1 ( P < .05). In T1, 9 mm implants had a higher ISQ than 11 mm ones ( P < .05), whereas in T2, the implants of 11 mm showed a higher ISQ than did the 9 mm implants ( P < .05). There was no difference in insertion torque between 9 and 11 mm implants ( P > .05), nor was there a correlation between ISQ and insertion torque ( P > .05). In conclusion, longer implants (11 mm) presented a significant increase in ISQ values during the healing period when installed in areas previously submitted to maxillary sinus lift. This phenomenon was not observed for shorter implants (9 mm). Finally, no correlation was observed between ISQ and insertion torque.

Relationship between implant stability measurements obtained by insertion torque and resonance frequency analysis: A systematic review

BACKGROUND

The primary stability of dental implants can be evaluated by insertion torque (IT) and resonance frequency analysis (RFA).

OBJECTIVE

Assess the supposed relationship between the IT and RFA.

MATERIALS AND METHODS

A systematic review was performed based on the PRISMA. The electronic search was performed in the PubMed, Web of Science, SCOPUS, Cochrane Library electronic, OVID, and Scielo databases. Manual searches were also performed. There was no restrictions regarding year of publication or language. The articles identified were assessed independently by 3 trained researchers. Clinical trials reporting the RFA values by means of implant stability quotient (ISQ) and IT were included.

RESULTS

The electronic and manual searches yielded 2017 studies. Twelve studies were included in the systematic review. There was no statistically significant correlation between ISQ and IT (r_s  = .366; P = .079). The quality of the evidence was downgraded by risk of bias and indirectness; and the certainty of the evidence was low.

CONCLUSION

IT and RFA are independent and incomparable methods of measuring primary stability. Is important for clinicians to define only one method of evaluation for each implant.

Low-level laser therapy with 940 nm diode laser on stability of dental implants: a randomized controlled clinical trial

Low-level laser therapy (LLLT) is a non-invasive modality to promote osteoblastic activity and tissue healing. The aim of this study was to evaluate the efficacy of LLLT for improvement of dental implant stability. This randomized controlled clinical trial was performed on 80 dental implants placed in 19 patients. Implants were randomly divided into two groups (n = 40). Seven sessions of LLLT (940 nm diode laser) were scheduled for the test group implants during 2 weeks. Laser was irradiated to the buccal and palatal sides. The same procedure was performed for the control group implants with laser hand piece in "off" mode. Implant stability was measured by Osstell Mentor device in implant stability quotient (ISQ) value immediately after surgery and 10 days and 3, 6, and 12 weeks later. Repeated measures ANOVA was used to compare the mean ISQ values (implant stability) in the test and control groups. Statistical test revealed no significant difference in the mean values of implant stability between the test and control groups over time (P = 0.557). Although the mean values of implant stability changed significantly in both groups over time (P < 0.05). Although the trend of reduction in stability was slower in the laser group in the first weeks and increased from the 6th to 12th week, LLLT had no significant effect on dental implant stability.

Relationship between implant stability on the abutment and platform level by means of resonance frequency analysis: A cross-sectional study

Resonance frequency analysis (RFA) has become the main tool used to assess the osseointegration of dental implants. The objective of this study was to verify the relationship between the ISQ values with different prosthetic abutments and with the implant platform. The hypothesis was that ISQ values changes according to the abutment height. Twelve patients were included, whose contribution to the study was 31 dental implants (external hexagon connection implants, 4.1x10 mm). The temporary implant-supported crown and prosthetic components were removed and the following smartpegs were inserted, one at a time: type 1, in the implant platform (G1); type A3, in the microunit component with 1mm transmucosal height (G2) and type A3, in the microunit component with 5mm transmucosal height (G3). In all the smartpegs, RFA measurements were taken on mesial, distal, buccal and lingual surfaces. All evaluations were performed by a single calibrated examiner (ICC = 0.989). Data were analyzed by Friedman and Spearman correlation tests and log-linear marginal regression (p<0.05). The mean age of participants was 52.83 (± 3.77) years. There was statistically significant difference (p<0.001) among the mean ISQ of G1 (88.27 ±5.70); G2 (72.75 ±4.73) and G3 (66.33 ±3.67). There was statistically significant negative correlation between the ISQ and the measurement distance (rs:-0.852; p<0.001; R2:0.553). Measurement distance was significantly associated (p<0.001) with ISQ value in the log-linear regression. The abutment height has a significant impact on resonance frequency analysis measurements. The higher the transmucosal abutment height, the lower the implant stability quotient value. Clinically, the ISQ measured on the abutment cannot be compared with values measured on the implant platform.

Tapered Implants in Dentistry: Revitalizing Concepts with Technology: A Review

The most common approach to lessen treatment times is by decreasing the healing period during which osseointegration is established. Implant design parameters such as implant surface, primary stability, thread configuration, body shape, and the type of bone have to be considered to obtain this objective. The relationship that exists between these components will define the initial stability of the implant. It is believed implant sites using a tapered design and surface modification can increase the primary stability in low-density bone. Furthermore, recent experimental preclinical work has shown the possibility of attaining primary stability of immediately loaded, tapered dental implants without compromising healing and rapid bone formation while minimizing the implant stability loss at compression sites. This may be of singular importance with immediate/early functional loading of single implants placed in poor-quality bone. The selection of an implant that will provide adequate stability in bone of poor quality is important. A tapered-screw implant design will provide adequate stability because it creates pressure on cortical bone in areas of reduced bone quality. Building on the success of traditional tapered implant therapy, newer tapered implant designs should aim to maximize the clinical outcome by implementing new technologies with adapted clinical workflows.

Improvement in the Initial Implant Stability Quotient Through Use of a Modified Surgical Technique

To ensure similar primary implant stability measured by resonance frequency analysis (RFA) could be obtained in different jawbone densities by using a specific surgical drilling protocol and, to correlate those RFA measurements with factors related to the implant design, width, and length, we are performed a 1-year prospective clinical study was carried out using 27 subjects. A total of 67 hydrophilic titanium implants were placed using a standard 2-stage implant placement protocol. The bone type at each implant site was determined by evaluation of a preoperative, high-resolution cone beam computerized tomography (CBCT) scan. A modified drilling protocol was used in softer bone (types 2, 3, and 4) that allowed for greater implant thread contact with the surrounding bone. The implant stability quotient (ISQ) was measured at 4 different times during the study: initially it was determined immediately after implant placement, then again at stage 2 uncovering surgery, then at 6 months' postplacement and, and finally at 1 year postplacement. Data collected immediately after implant surgery demonstrated a high correlation (R2 = .99) between the ISQ and bone type classification. An overall trend toward a higher ISQ was found over the 1-year study period for all types of bone. Implants remained clinically and radiographically stable during the 1-year study period. Our data allow conclude that the primary stability of 2-staged loaded implants placed in different bone types can be optimized by applying this surgical drilling protocol during the implant placement. The ISQ method was found to be a reliable predictor of implant stability.

Correlation between Implant Stability Quotient (ISQ) with Clinical and Histological Aspects of Dental Implants Removed for Mobility

Dental implants are a successful treatment modality for missing teeth; however, failures do occur. These failures can occur early in the healing process after primary stability has been achieved at the time of implant placement, or after initial bone remodeling and new bone growth have taken place. The ability to detect implants that are failing or will fail is still not possible. The aim of the present study is to see if correlations exist between RFA values and histologic and histochemical evaluation of the human retrieved implants for failure. In a 5 year period, 37 root form implants were retrieved because of mobility and underwent histological examination. Thin ground sections were obtained from each implant. All the implants had been removed with a 5 mm trephine. In all cases a peri-implant radiolucency was present. Before implant retrieval, the implant stability was evaluated with Osstell (Integration Diagnostics AB, Gothenburg, Sweden). All the implants were not osseointegrated clinically and mobility was present. Radiographically, bone loss was observed around the implants and the mean ISQ values was 37 (+/- 2.7). A scarce inflammatory cell infiltrate was present in the connective tissue of some specimens. In about 10 percent of specimens, the epithelium tended to surround the total perimeter of the implant. These data suggest that implants with an ISQ<40 are irretrievably lost and there is no possibility to save them. A statistically significant correlation was found between an ISQ<36 and irretrievably failed implants.

A resonance frequency analysis of sandblasted and acid-etched implants with different diameters: a prospective clinical study during the initial healing period

Purpose

The possibility of immediate or early loading has become popular in implant dentistry. A prerequisite for the immediate or early loading of an implant prosthesis is the achievement of initial stability in the implant. Moreover, in response to clinicians' interest in verifying clinical stability to determine the optimal time point for functional loading, a non-invasive method to assess implant stability has been developed on the basis of resonance frequency analysis (RFA). The primary objective of this study was to monitor the stability of sandblasted, large-grit, and acid-etched (SLA) implants with different diameters during the early phases of healing by RFA. The secondary objective was to evaluate how the initial stability of implants varied depending on different surface modifications and other contributing factors.

Methods

Thirty-five implants (25 SLA implants and 10 resorbable blasting media [RBM] implants) placed in 20 subjects were included. To measure implant stability, RFA was performed at baseline and at 1, 2, 3, 4, 6, and 10 weeks after surgery.

Results

The longitudinal changes in the implant stability quotient (ISQ) values were similar for the SLA implants with different diameters and for the RBM implants. During the initial healing period, the ISQ decreased after installation and reached its lowest values at 1 week and 2 weeks, respectively. The mean ISQ values in the SLA implants were significantly higher in Ø 5.0 mm implants than in Ø 4.0 mm implants. Men showed a higher ISQ than women. Mandibular sites showed a higher ISQ than maxillary sites.

Conclusions

All implants used in this study are suitable for immediate or early loading under appropriate indications. A wider diameter and SLA surface treatment of implants could improve the stability, if the implant is fixed with at least 30 Ncm of insertion torque.

Evaluation of the osseointegration of dental implants coated with calcium carbonate: an animal study

In an attempt to overcome the limitations of titanium in dental and orthopaedic clinical applications, a new method has been developed to prepare calcium carbonate coatings on sandblasted and acid-etched (SA) titanium implants. The purpose of this study was to investigate the effect of calcium carbonate-SA (CC-SA) implants on osseointegration in vivo. The surfaces of SA and CC-SA implants were characterised for surface morphology and surface chemistry. Subsequently, these two kinds of implants were implanted in the femoral condyles of rabbits. The implants were retrieved and prepared for histological and histomorphometric evaluation 1, 2, 4, 8 and 12 weeks after implantation. Significantly higher values of bone-to-implant contact of the entire implant except the gap area (BIC_ALL) and the bone-to-implant contact of the gap area (BIC_GAP) were found in animals with the CC-SA implants than in those with the SA implants at 4 weeks. Higher values of total gap bone were found in those with the CC-SA implants than in those with the SA implants at 1, 2 and 4 weeks. In conclusion, the current findings demonstrate that the calcium carbonate coating can improve and accelerate the early ingrowth of bone and osseointegration at the early healing phase. This may reduce clinical healing times and thus improve implant success rates.

The effect of 2 versus 4 implants on implant stability in mandibular overdentures: A randomized controlled trial

STATEMENT OF PROBLEM

Dental research is rich with articles that investigated the influence of host-site variables, some implant-related variables (implant length, diameter, taper, design, location, and surface topography), different loading protocols or surgical procedures, and measurement methodology on dental implant stability. However, the number of implants and its effect on implant stability remain unclear.

PURPOSE

The purpose of this randomized clinical trial was to investigate the influence of implant number on implant stability by comparing 2 versus 4 implants in mandibular implant overdentures.

MATERIAL AND METHODS

The trial included 20 participants with edentulous mandibular ridges. Participants were randomly assigned to 2 equal groups, a 4-implant (experimental) group consisting of 4 implants installed in lateral-canine and premolar regions; and a 2-implant (control) group, consisting of 2 implants in lateral-canine regions. Implant stability was measured using resonance frequency analysis at implant placement and then at 1, 3, 6, 9, and 12 months. The Student t test was used to compare the implant stability quotient (ISQ) values of the anterior implants in the 4-implant and 2-implant groups. One-way ANOVA followed by the post hoc Bonferroni test was used to compare ISQ values among the different follow-up periods within each group (α=.05).

RESULTS

Mean ISQ values for anterior implants in the 4-implant group were slightly higher than those recorded for the 2-implant group at all follow-up periods. However, these differences were not statistically significant (P>.05). Within-group comparison revealed an initial decrease in implant stability for all implants. This decrease was statistically significant for the 2-implant group (P<.001) and for posterior implants in the 4-implant group (P<.001). This was then followed by a gradual increase in ISQ values for all implants in both groups.

CONCLUSIONS

Increasing the number of implants from 2 to 4 in mandibular implant overdentures did not have a significant influence on implant stability.

Platelet-Rich Fibrin (PRF) in Implants Dentistry in Combination with New Bone Regenerative Flapless Technique: Evolution of the Technique and Final Results

Most common techniques for alveolar bone augmentation are guided bone regeneration (GBR) and autologous bone grafting. GBR studies demonstrated long-term reabsorption using heterologous bone graft. A general consensus has been achieved in implant surgery for a minimal amount of 2 mm of healthy bone around the implant. A current height loss of about 3-4 mm will result in proper deeper implant insertion when alveolar bone expansion is not planned because of the dome shape of the alveolar crest. To manage this situation a split crest technique has been proposed for alveolar bone expansion and the implants' insertion in one stage surgery. Platelet-rich fibrin (PRF) is a healing biomaterial with a great potential for bone and soft tissue regeneration without inflammatory reactions, and may be used alone or in combination with bone grafts, promoting hemostasis, bone growth, and maturation.

AIM

The aim of this study was to demonstrate the clinical effectiveness of PRF combined with a new split crest flapless modified technique in 5 patients vs. 5 control patients.

MATERIALS AND METHODS

Ten patients with horizontal alveolar crests deficiency were treated in this study, divided into 2 groups: Group 1 (test) of 5 patients treated by the flapless split crest new procedure; Group 2 (control) of 5 patients treated by traditional technique with deeper insertion of smaller implants without split crest. The follow-up was performed with x-ray orthopantomography and intraoral radiographs at T0 (before surgery), T1 (operation time), T2 (3 months) and T3 (6 months) post-operation.

RESULTS

All cases were successful; there were no problems at surgery and post-operative times. All implants succeeded osteointegration and all patients underwent uneventful prosthetic rehabilitation. Mean height bone loss was 1 mm, measured as bone-implant most coronal contact (Δ-BIC), and occurred at immediate T2 post-operative time (3 months). No alveolar bone height loss was detected at implant insertion time, which was instead identified in the control group because of deeper implant insertion.

CONCLUSION

This modified split crest technique combined with PRF appears to be reliable, safe, and to improve the clinical outcome of patients with horizontal alveolar crests deficiency compared to traditional implanting techniques by avoiding alveolar height-loss related to deeper insertion of smaller implants.

Evaluation of effectiveness of concentrated growth factor on osseointegration

BACKGROUND

Growth factor-containing products have been reported to increase implant stability and accelerate osseointegration. Concentrated growth factor (CGF) can be used for this purpose with the growth factors it contains. The aim of this study is to assess the effect of CGF on implant stability and osseointegration.

METHODS

Twelve patients with maxillary anterior toothless were included in the study. Implant cavities prepared in the study group were covered with CGF membrane before implant placement, but conventional implant placement was performed in the control group. Resonance frequency measurements were performed with the Osstell device intra-operatively, post-operatively, at the 1st week, and at the 4th week.

RESULTS

The mean ISQ values were found to be 79.40 ± 2.604 for the study group and 73.50 ± 5.226 for the control group at 1st week, 78.60 ± 3.136 for the study group and 73.45 ± 5.680 for the control group at 4th week. The differences between the groups were statistically significant (p < 0.05).

CONCLUSIONS

It was observed that the concentrated growth factor had positive effects on implant stabilization. The ISQ measurements at week 1 and week 4 were notably higher in the study group. Application of this material seems to accelerate osseointegration.

Improved in vitro angiogenic behavior on anodized titanium dioxide nanotubes

Background

Neovascularization over dental implants is an imperative requisite to achieve successful osseointegration onto implanted materials. The aim of this study was to investigate the effects on in vitro angiogenesis of anodized 70 nm diameter TiO₂ nanotubes (NTs) on Ti6Al4V alloy synthesized and disinfected by means of a novel, facile, antibacterial and cost-effective method using super oxidized water (SOW). We also evaluated the role of the surface roughness and chemical composition of materials of materials on angiogenesis.

Methods

The Ti6Al4V alloy and a commercially pure Ti were anodized using a solution constituted by SOW and fluoride as electrolyte. An acid-etched Ti6Al4V was evaluated to compare the effect of micro-surface roughness. Mirror-polished materials were used as control. Morphology, roughness, chemistry and wettability were assessed by field emission scanning electron microscopy (FE-SEM), transmission electron microscopy, atomic force microscopy, energy dispersive X-ray spectroscopy (EDX) and using a professional digital camera. Bovine coronary artery endothelial cells (BCAECs) were seeded over the experimental surfaces for several incubation times. Cellular adhesion, proliferation and monolayer formation were evaluated by means of SEM. BCAEC viability, actin stress fibers and vinculin cellular organization, as well as the angiogenic receptors vascular endothelial growth factor 2 (VEGFR2) and endothelial nitric oxide synthase (eNOS) were measured using fluorescence microscopy.

Results

The anodization process significantly increased the roughness, wettability and thickness of the oxidized coating. EDX analysis demonstrated an increased oxygen (O) and decreased carbon (C) content on the NTs of both materials. Endothelial behavior was solidly supported and improved by the NTs (without significant differences between Ti and alloy), showing that endothelial viability, adhesion, proliferation, actin arrangement with vinculin expression and monolayer development were evidently stimulated on the nanostructured surface, also leading to increased activation of VEGFR2 and eNOS on Ti6Al4V-NTs compared to the control Ti6Al4V alloy. Although the rougher alloy promoted BCAECs viability and proliferation, filopodia formation was poor.

Conclusion

The in vitro results suggest that 70 nm diameter NTs manufactured by anodization and cleaned using SOW promotes in vitro endothelial activity, which may improve in vivo angiogenesis supporting a faster clinical osseointegration process.

Alveolar Ridge Split Technique Using Piezosurgery with Specially Designed Tips

The treatment of patients with atrophic ridge who need prosthetic rehabilitation is a common problem in oral and maxillofacial surgery. Among the various techniques introduced for the expansion of alveolar ridges with a horizontal bone deficit is the alveolar ridge split technique. The aim of this article is to give a description of some new tips that have been specifically designed for the treatment of atrophic ridges with transversal bone deficit. A two-step piezosurgical split technique is also described, based on specific osteotomies of the vestibular cortex and the use of a mandibular ramus graft as interpositional graft. A total of 15 patients were treated with the proposed new tips by our department. All the expanded areas were successful in providing an adequate width and height to insert implants according to the prosthetic plan and the proposed tips allowed obtaining the most from the alveolar ridge split technique and piezosurgery. These tips have made alveolar ridge split technique simple, safe, and effective for the treatment of horizontal and vertical bone defects. Furthermore the proposed piezosurgical split technique allows obtaining horizontal and vertical bone augmentation.

The factors that influence postoperative stability of the dental implants in posterior edentulous maxilla

Background

All clinicians are aware of the difficulty of installing a dental implant in posterior maxilla because of proximate position of maxillary sinus, insufficient bone width, and lower bone density. This study is to examine which factors will make the implantation in the posterior maxilla more difficult, and which factors will affect the postoperative implant stability in this region.

Methods

Five hundred seventy-three fixtures on the maxilla posterior were included for this study from all the patients who underwent an installation of the dental implant fixture from January 2010 to December 2014 at the Department of Oral and Maxillofacial Surgery in Pusan National University Dental Hospital (Yangsan, Korea). The postoperative implant stability quotient (ISQ) value, fixture diameter and length, presence of either bone graft or sinus lift, and graft material were included in the reviewed factors. The width and height of the bone bed was assessed via preoperative cone beam CT image analysis. The postoperative ISQ value was taken just before loading by using the OsstellTM mentor® (Integration Diagnostics AB, Gothenburg, Sweden). The t test and ANOVA methods were used in the statistical analysis of the data.

Results

Mean ISQ of all the included data was 79.22. Higher initial bone height, larger fixture diameter, and longer fixture length were factors that influence the implant stability on the posterior edentulous maxilla. On the other hand, the initial bone width, bone graft and sinus elevation procedure, graft material, and approach method for sinus elevation showed no significant impact associated with the implant stability on the posterior edentulous maxilla.

Conclusions

It is recommended to install the fixtures accurately in a larger diameter and longer length by performing bone graft and sinus elevation.

Use of a trephine bur and curette for minimally invasive harvesting of particulate cancellous bone and marrow from the iliac crest: a case of alveolar ridge reconstruction

Iliac particulate cancellous bone and marrow (PCBM) is still the most predictable autogenous graft material for vertical ridge reconstruction because of its high cell content as well as osteoinductive and osteoconductive properties. However, postoperative meralgia paresthetica, gait disturbance, pain, and bleeding have been reported following conventional harvesting from the anterior iliac crest. We present a case of minimally invasive harvesting of iliac PCBM. A short incision was made, and the iliac crest was exposed after elevation of the periosteal membrane. Only the iliac cortical bone was removed using a trephine bur to avoid perforation. PCBM was harvested with hand curettes and grafted into the vertical ridge defect. Because of the small surgical field, gait disturbance was resolved within 1 day without other postoperative complications. This technique is potentially useful for harvesting a small amount of iliac PCBM.

Mathematical evaluation of the influence of multiple factors on implant stability quotient values in clinical practice: a retrospective study

Objectives

The objective of this study is to mathematically evaluate the influence of multiple factors on implant stability quotient values in clinical practice.

Patients and methods

Resonance frequency analysis was performed at T1 (measured immediately at the time of implant placement) and at T2 (measured before dental restoration) in 177 patients (329 implants). Using a multivariate linear regression model, we analyzed the influence of the following eleven candidate factors: sex, age, maxillary/mandibular location, bone type, immediate/delayed implantation, bone grafting (presence or absence), insertion torque, I-/II-stage healing pattern, implant diameter, implant length, and T1–T2 time interval.

Results

The following factors were identified to significantly influence the implant stability quotient (ISQ) values at T1: insertion torque, bone grafting, I-/II-stage healing pattern, immediate/delayed implantation, maxillary/mandibular location, implant diameter, and sex. In contrast, the ISQ values at T2 were significantly influenced only by three factors: implant diameter, T1–T2 time interval, and insertion torque.

Conclusion

Among the eleven candidate factors, seven key factors were found to influence the T1-ISQ values, while only three key factors influenced the T2-ISQ values. Both T1 and T2-ISQ values were found to be influenced by implant diameter and insertion torque. T1 was influenced specifically by the sex of the patient, the location (maxillary or mandibular), the implantation mode (immediate/delayed implantation), the healing stage, and the absence or presence of bone graft materials.

Stability and Crestal Bone Behavior Following Simultaneous Placement of Multiple Dental Implants (Two or More) with the Bone Splitting Technique: A Clinical and Radiographic Evaluation

PURPOSE

The present study aimed to measure the implant stability quotient (ISQ) values at three different time points after surgical procedures and crestal bone behavior in multiple implants (two or more) installed simultaneously with the bone splitting technique.

MATERIALS AND METHODS

For this study, 45 patients with different edentulous areas in the maxilla were selected, and a total of 114 dental implants were installed. Implant stability was measured by resonance frequency analysis immediately following implant placement to assess immediate stability (time 1) and stability at 90 days (time 2), and 150 days (time 3). Crestal bone height was measured in peri-apical radiographs at 90 and 150 days after implantation in relation to each implant shoulder, given that the implants were installed at the level of the crestal bone.

RESULTS

Six implants were not osseointegrated. Overall, the means and standard deviations of the ISQ values were 60.3 ± 4.94 (95% confidence interval [CI], 44-69) at baseline, 66.6 ± 5.28 (95% CI, 49-75) at 90 days, and 72.1 ± 4.28 (95% CI, 59-79) at 150 days (p < 0.0001). The mean marginal bone loss of the implants was 1.11 ± 0.61 mm on the mesial side and 1.17 ± 0.61 mm on the distal side at time 2, and 1.73 ± 0.68 mm on the mesial side and 1.79 ± 0.70 mm on the distal side at time 3. A strong positive correlation between implant stability and bone loss was detected (p < 0.0001).

CONCLUSIONS

Within the limits of this study, the bone splitting technique with simultaneous implant installation exhibited a good success rate with respect to the osseointegration index but requires attention with respect to crestal bone behavior.

Evaluation of the insertion torque, implant stability quotient and drilled hole quality for different drill design: an in vitro Investigation

OBJECTIVE

The purpose of the present study was to compare the insertion torque and implant stability quotient between different drill design for implant site preparation.

MATERIALS AND METHODS

Synthetic blocks of bone (type I density) were used for drilling procedures. Three groups were evaluated: Group G1 - drilling with a single bur for a 4.2 mm conical implant; Group G2 and Group G3 - drilling with three consecutive burs for a 4.1 mm cylindrical implant and for a 4.3 mm conical implant respectively. For each group, 15 drilling procedures were performed without irrigation for 10-mm in-depth. The drilled hole quality (HQ) after the osteotomy for implant site preparation was measured in the five-first holes through a fully automated roundness/cylindricity instrument at three levels (top, middle, and bottom of the site). The insertion torque value (ITV) was achieved with a computed torquimeter and the implant stability quotient (ISQ) values were measured using a resonance frequency apparatus.

RESULTS

The single drill (group 1) achieved a significantly higher ITV and ISQ than the multiple drills for osteotomy (groups 2 and 3). Group 1 and 3 displayed significantly better HQ than group 2.

CONCLUSIONS

Within the limitations of the study, the results suggest that the hole quality, in addition to the insertion torque, may significantly affect implant primary stability.

Determination of the Optimum Torque to Tighten the Smartpegs of Magnetic Resonance Frequency Analyses Devices: An Ex Vivo Study

The aim of this study was to find an optimal value for tightening the Smartpegs for magnetic radiofrequency analysis devices (RFAs) devices. Thirty implants were placed in 3 cow ribs. The RFA value of each implant was measured in buccal and mesial directions after tightening the Smartpegs with 1, 3, 4, 8, 9, 10, and 11 Ncm. Additionally, 4 different examiners measured the RFA after hand tightening the Smartpegs, and the results were compared. The buccal implant stability quotient (ISQ) values when the Smartpegs were tightened to 1Ncm were significantly lower than the ISQ values when the Smartpegs were tightened to 3, 4, 8, 9, 10, and 11 Ncm (P &lt; .05). The mesial ISQ values when the Smartpegs were tightened to 1, 3, and 4 Ncm were significantly lower than the ISQ values when the Smartpegs were tightened with higher torque values (P &lt; .05). The buccal measurements made by 1 examiner was significantly lower than 3 Ncm (P &lt; .05), and the buccal measurements made by 1 examiner was significantly lower than 4 Ncm (P &lt; .05). The mesial ISQ values measured by 2 examiners were significantly lower than 3 Ncm (P &lt; .05), and the mesial ISQ values measured by the other 2 examiners were significantly lower than 8 Ncm (P &lt; .05). The tightening of the Smartpegs should be standardized by the manufacturer to a range of 5-8 Ncm in order to gain reliable objective RFA values, instead of leaving it to subjective finger pressure.

Does the time of osseointegration in the maxilla and mandible differ?

OBJECTIVES

The objectives of the present study were to measure the implant stability quotient (ISQ) values at 3 different time points after the surgical insertion and to determine whether the time of osseointegration differs in the maxilla and mandible.

MATERIALS AND METHODS

To measure implant stability, resonance frequency analysis (RFA) was performed in 44 patients (40 women, 4 men) with a total of 100 Implacil De Bortoli implants; the patients were divided into 2 groups: group 1, implants in the maxilla (22 in the anterior maxilla and 37 in the posterior maxilla); and group 2, implants in the mandible (41 posterior mandibles). Using RFA, implant stability was measured immediately after implant placement to assess the immediate stability (time 1) and at 90 (time 2) and 150 (time 3) days.

RESULTS

Overall, the mean (SD) ISQ was 63.3 (6.63) (95% confidence interval [CI], 39-79) for time 1, 70.5 (6.32) (95% CI, 46-88) for time 2, and 73.5 (6.03) (95% CI, 58-88) for time 3. In group 1, the mean (SD) ISQ was 61.8 (6.56) (95% CI, 39-79) for time 1, 68.8 (5.19) (95% CI, 57-83) for time 2, and 72.3 (5.91) (95% CI, 58-85) for time 3. In group 2, the mean (SD) ISQ was 65.5 (6.13) (95% CI, 44-75) for time 1, 72.9 (7.02) (95% CI, 46-88) for time 2, and 75.3 (5.80) (95% CI, 60-88) for time 3.

CONCLUSIONS

The stability of the implants placed in the maxilla and mandible showed a similar evolution in the ISQ values and, consequently, on osseointegration; however, the implants in the mandible presented superior values at all time points.

An in vitro evaluation of resonant frequency analysis to measure fixed bridge stability

Objectives/Aims:

To determine whether a clinically available resonance frequency analysis (RFA) device (Osstell Mentor), designed to assess implant integration, could identify a single uncemented retainer on fixed–fixed bridges, in vitro.

Materials and Methods:

All-metal fixed–fixed bridges were cemented to acrylic tooth analogue abutments with simulated periodontal ligaments. Dental stone bases provided 100 or 50% ‘bone support’ groups (n = 50 in each). Control groups had both retainers cemented, whereas the test groups had the ‘premolar’ uncemented, mimicking clinical failure. A RFA device was used to measure bridge stability, expressed as a modified Implant Stability Quotient (Bridge Stability Quotient—BSQ) from a Smartpeg temporarily affixed to the bridge via composite.

Results:

The BSQ recorded at the premolar site in both 100 and 50% support models demonstrated highly statistically significant differences (P <0.003) between the control and test groups. Sensitivity and specificity, area under the curve (receiver operating characteristic), analyses showed moderate test accuracy (0.735) for the 100% support group and good accuracy (0.96) for the 50% support group.

Conclusion:

The investigation suggests that RFA measurements were able to identify, reliably and non-destructively, in vitro, fixed–fixed bridges where the anterior retainer was uncemented. Further clinical research is required to determine whether this technique may allow early diagnosis of failing bridgework.

Implant stability change and osseointegration speed of immediately loaded photofunctionalized implants

OBJECTIVES

This study evaluated the degree and rate of implant stability development for photofunctionalized dental implants in humans.

MATERIALS AND METHODS

Thirty-three implants (7 patients) placed in the maxilla and immediate loaded were evaluated. Photofunctionalization was performed by treating implants with ultraviolet for 15 minutes immediately before placement. Implant stability was assessed by measuring the implant stability quotient (ISQ) weekly starting from implant placement up to 3 months. Osseointegration speed index (OSI), defined as ISQ increase per month, was also evaluated.

RESULTS

The average ISQ for photofunctionalized implants at week 6 was 78.0, which was considerably higher than the average ISQ of 66.1, reported in literature for various as-received implants after a longer healing time of 2 to 6 months. No stability dip was observed for photofunctionalized implants regardless of the initial ISQ values. The OSI for photofunctionalized implants was 6.3 and 3.1 when their initial ISQ was 65 to 70 and 71 to 75, respectively, whereas the OSI values for as-received implants calculated from literature ranged from -3.0 to 1.17 with an average of -0.10.

CONCLUSIONS

Photofunctionalization accelerated and enhanced osseointegration of dental implants, providing novel and practical avenues for further advancement in implant therapy.

Comparison of Azithromycin and Amoxicillin Before Dental Implant Placement: An Exploratory Study of Bioavailability and Resolution of Postoperative Inflammation

BACKGROUND

Studies suggest that a single prophylactic dose of amoxicillin reduces early implant complications, but it is unclear whether other antibiotics are also effective. This study compared the local antimicrobial and anti-inflammatory effects resulting from a single dose of azithromycin or amoxicillin before surgical placement of one-stage dental implants.

METHODS

Healthy adult patients requiring one-stage dental implant placement were allocated randomly to receive either 2 g amoxicillin (n = 7) or 500 mg azithromycin (n = 6) before surgery. Peri-implant crevicular fluid (PICF) samples from the new implant and gingival crevicular fluid (GCF) from adjacent teeth were sampled on postoperative days 6, 13, and 20. Inflammatory mediators in the samples were analyzed by immunoassay, and antibiotic levels were measured by bioassay.

RESULTS

On day 6, azithromycin concentrations in GCF and PICF were 3.39 ± 0.73 and 2.77 ± 0.90 μg/mL, respectively, whereas amoxicillin was below the limit of detection. During early healing, patents in the azithromycin group exhibited a significantly greater decrease in GCF volume (P = 0.03, analysis of variance). At specific times during healing, the azithromycin group exhibited significantly lower levels of interleukin (IL)-6 and IL-8 in GCF than the amoxicillin group and exhibited significantly lower levels of granulocyte colony stimulating factor, IL-8, macrophage inflammatory protein-1β, and interferon-gamma-inducible protein-10 in PICF.

CONCLUSIONS

Azithromycin was available at the surgical site for a longer period of time than amoxicillin, and patients taking azithromycin exhibited lower levels of specific proinflammatory cytokines and chemokines in GCF and PICF. Thus, preoperative azithromycin may enhance resolution of postoperative inflammation to a greater extent than amoxicillin.

Osstell Resonance Frequency Measurement Values as a Prognostic Factor in Implant Dentistry

Resonance frequency analysis (RFA) using the Osstell device (Osstell AB, Gothenburg, Sweden) has been advocated for quantifying implant stability on a relative scale of implant stability quotients (ISQ). It was the goal of this prospective clinical study to evaluate whether a certain ISQ level, at the time an implant is placed, correlates with successful osseointegration as some have claimed. Four hundred ninety-five implants (Straumann AG, Basel, Switzerland), varying in length and diameter, were placed in a private practice, strictly adhering to the implant manufacturer's surgical protocol. After placement and after healing periods of 42 days in the mandible and 56 days (implant manufacturer's protocol) in the maxilla, implant stability was measured using RFA. After healing, implants were torqued forward at 35 Ncm and allowed to heal further if the patients felt discomfort. Statistical analysis of the data obtained was based on Welch tests and Kolmogorov-Smirnow tests (level of significance α = 0.05). Results showed that 432 implants were osseointegrated after the predefined healing periods while 8 implants were lost and, in 55 cases, healing was prolonged. Both at insertion (P = .025) and after healing (P &lt; .001), successful implants showed significantly different ISQ values as compared to implant failures or implants with prolonged healing. However, overlapping ISQ distributions at implant insertion demonstrated that there was no correlation among the data that could be used to predict successful osseointegration. Within the limits of this study, the prognostic value of ISQ values appears to be ambiguous.

Dental Extractions and Preservation of Space for Implant Placement in Molar Sites

The clinician is often asked to remove a tooth and place an implant into the site. The implant must be placed with appropriate stability to allow for integration to occur, which requires bone presence. Bone is also necessary to allow for ideal implant positioning within the alveolus for functional and esthetic concerns. The purpose of this article is to discuss the changes in socket dimensions over time and how to promote space maintenance, with an algorithm for treatment based on evidence.

Stability of implants placed in fresh sockets versus healed alveolar sites: Early findings

OBJECTIVES

The present study measured implant stability quotient (ISQ) values at three different time points after surgical procedures to compare whether the stability values differed between implants placed in fresh extraction sockets versus healed alveolar sites.

MATERIALS AND METHODS

To measure implant stability, resonance frequency analysis (RFA) was performed in 77 patients (53 women, 24 men) with a total of 120 dental implants. These implants were divided into two groups: Group 1 included 60 implants in healed alveolar sites (22 in the maxilla, 38 in the mandible), and Group 2 included 60 implants in fresh sockets (41 in the maxilla, 19 in the mandible). Implant stability was measured immediately at implant placement (baseline), 90, and 150 days later. Statistical analysis was made using a multivariate regression linear model at implant level (α = 0.05).

RESULTS

Overall, the means and standard deviations of the ISQ values were 62.7 ± 7.14 (95% confidence interval [CI], 39-88) at baseline, 70.0 ± 6.22 (95% CI, 46-88) at 90 days, and 73.4 ± 5.84 (95% CI, 58-88) at 150 days. In Group 1, the ISQs ranged between 64.3 ± 6.20 and 75.0 ± 5.69, while in Group 2, presented lower values that ranged between 61.2 ± 8.09 and 71.9 ± 5.99 (P = 0.002). Anatomic location and times periods were the only identified variables with an influence on ISQ values at implant level (P < 0.0001).

CONCLUSIONS

The stabilities of the implants placed in the fresh sockets and in healed sites exhibited similar evolutions in ISQ values and thus osseointegration; however, the implants in the healed alveolar sites exhibited superior values at all time points.

Effect of low speed drilling on osseointegration using simplified drilling procedures

Our aim was to find out whether simplified drilling protocols would provide biological responses comparable to those of conventional drilling protocols at the low rotational speed of 400rpm. Seventy-eight root form endosseous implants with diameters of 3.75, 4.2, and 5mm were placed into canine tibias and allowed to heal for 3 and 5 weeks. After the dogs had been killed, the samples of implanted bone were retrieved and processed for non-decalcified histological sectioning. Bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO) analyses were made on the histological sections. Implants treated by the simplified protocol resulted in BIC and BAFO values comparable to those obtained with the conventional drilling protocol, and there were no significant differences in the technique or diameter of the drilling. The results suggest that the simplified procedure gives biological outcomes comparable to those of the conventional procedure.

The Influence of Tactile Perception on Classification of Bone Tissue at Dental Implant Insertion

BACKGROUND

Various ways of using the Lekholm and Zarb (L&Z) classification have added to the lack of scientific evidence of the effectiveness of this clinical method in the evaluation of implant treatment.

PURPOSE

The study aims to assess subjective jawbone classifications in patients referred for implant treatment, using L&Z classification with and without surgeon's hand perception at implant insertion. The association between bone type classifications and quantitative parameters of primary implant stability was also assessed.

MATERIALS AND METHODS

One hundred thirty-five implants were inserted using conventional loading protocol. Three surgeons classified bone quality at implant sites using two methods: one based on periapical and panoramic images (modified L&Z) and one based on the same images associated with the surgeon's tactile perception during drilling (original L&Z). Peak insertion torque and implant stability quotient (ISQ) were recorded.

RESULTS

The modified and original L&Z were strongly correlated (rho = 0.79; p < .001); Wilcoxon signed-rank test showed no significant difference in the distribution of bone type classification between pairs using the two methods (p = .538). Spearman correlation tested the association between primary stability parameters and bone type classifications (-0.34 to -0.57 [p < .001]).

CONCLUSIONS

Tactile surgical perception has a minor influence on rating of subjective bone type for dental implant treatment using the L&Z classification.

Why guided when freehand is easier, quicker, and less costly?

Computer-assisted implant planning and subsequent production of a surgical template based on this plan has gained attention because it provides restoratively driven esthetics, patient comfort, satisfaction, and the option of flapless surgery and immediate restoration. However, it adds expense and requires more time. Another significant but not so apparent advantage may be improved survival and success over freehand techniques in types III and IV bone. This retrospective analysis was undertaken to examine that possibility. It reports 1-year outcome for 80 implants in 27 consecutively presenting patients treated over a 7-year period using computer-assisted techniques across all bone qualities in commonly encountered treatment indications in private practice. Implants were placed to support single teeth, small bridges, and complete arch restorations in exposed or immediately restored applications, based on primary stability as determined by insertion torque, resonance frequency analysis, and Periotest. For the 80 implants supporting 35 restorations, the median observation period is 2.66 years; 73 implants supporting prostheses in 22 patients had readable radiographs at 1 year. There was a 1-year overall implant survival and a success rate of 100%. Radiographic analysis demonstrated the change in bone level from the platform at 1-year is less than 2 mm. Intra-operative median measurements of primary stability were insertion torque, 40 Ncm; resonance frequency, 76 ISQ; and Periotest, -3. All intra-operative measurements were consistent for acceptable primary stability regardless of bone density. Restoratively driven diagnosis and precision planning and initial fit were possible with computer-assisted techniques resulting in the achievement of high primary stability, even in areas of less dense bone. The ability to plan implant position, drill sequence, and implant design on the basis of predetermined bone density gives the practitioner enhanced pretreatment information which can lead to improved outcome.

Platelet-Rich Fibrin in Maxillary Sinus Augmentation: A Systematic Review

The aim of this study was to systemically assess the efficacy of platelet-rich fibrin (PRF) on maxillary sinus augmentation using the lateral approach. A PubMed search and a hand search of relevant journals and the bibliographies of selected articles were performed. Clinical studies using PRF with open maxillary sinus augmentation were included. The search provided 290 titles; only 8 studies fulfilled the inclusion criteria. Identified studies showed heterogeneity regarding surgical technique, grafting material, implant placement time, protocol, outcome measures, healing time for biopsy, and implant placement, as well as follow-up period. From the 8 identified studies, 3 studies used PRF as a sole filling material, whereas the other 5 studies used PRF with bone substitutes. PRF showed promising results as a sole filling material for sinus lift with simultaneous implant placement, and PRF seemed to accelerate maturation of a demineralized freeze dried bone allograft. Conversely, it had no effect on deproteinized bovine maturation. PRF fibrin membranes represent an easy and successful method to cover the sinus membrane or osteotomy window.

Sensitivity and Specificity of Stability Criteria for Immediately Loaded Splinted Maxillary Implants

BACKGROUND

To assess the suitability of dental implants for immediate loading, primary stability is usually evaluated intraoperatively.

PURPOSE

This retrospective study aimed to assess the suitability of three stability parameters - namely, insertion torque (IT), implant stability quotient (ISQ; measured by resonance frequency analysis), and Periotest (PT) values - as potential predictors for the risk of nonosseointegration of immediately loaded splinted implants. The stability parameters were routinely collected under immediate loading.

MATERIALS AND METHODS

Nineteen patients with 11 edentulous and 8 partially edentulous maxillae were treated with 105 dental implants, which were immediately loaded using temporary fixed dentures. The IT results, PT values, and ISQ results were recorded. Receiver operating characteristic analysis was performed to assess the quality of each parameter as a diagnostic test.

RESULTS

After a 3-month observation period, 11 implants in four patients were not osseointegrated. The IT and ISQ (IT 25.0 ± 12.5 Ncm and 8.4 ± 2.3 Ncm; PT -1.5 ± 3.0 and +2.7 ± 3.0; and ISQ 62.6 ± 6.7 and 54.7 ± 6.2) differed significantly between the osseointegrated and failed implants (p < .005). The IT showed the greatest specificity at a sensitivity of 1 and the greatest area under the curve (AUC; 0.929), followed by the PT value (AUC = 0.836) and ISQ (AUC = 0.811).

CONCLUSIONS

Among the intraoperative parameters analyzed, IT showed the highest specificity at a high sensitivity of 1. Therefore, the IT can be considered the most valid prognostic factor for osseointegration of immediately loaded splinted dental implants.