Clinical analysis of the stability of dental implants after preparation of the site by conventional drilling or piezosurgery

The Effect of Denatured Albumin with Concentrated Growth Factors in Minimally Invasive Sinus Piezosurgery: Preliminary Pilot Study Results

A new protocol with albumin-concentrated growth factor (CGF) is investigated through Piezosurgery as a minimally invasive alternative to sinus-floor-augmentation that is associated with high morbidity and high incidence of sinusitis. The clinical sample consists of five patients (three men and two women) with an average age of 53.75 ± 3.59 years and a mean height of 3.7 ± 1.22 mm of residual bone. The Piezo-Alb-CGF protocol consists of a minimally invasive transcrestal approach with or without flap, piezosurgery preparation, applying the Schneiderian membrane's hydrodynamic detachment-elevation, injecting albumin-CGF into the sinus, optional bone grafting and implantation, and evaluation for 2 to 6 months postoperatively. Eight implants were placed without complications. After 4 to 6 months, cone-beam computed tomography and panoramic radiographs showed total osseointegration and the formation of new bone. In addition, a year of clinical follow-up was performed. There was a positive correlation between implant stability quotient values at all protocol stages. The significance level was 5%. Albumin-CGF regenerative protocol promotes new bone formation, reduces postoperative morbidity, and shortens healing time. It also offers a uniform and safe hydraulic membrane lift and bicortical implant fixation, even in cases with a residual bone height below 6 mm.

Primary Stability of Implants Inserted into Polyurethane Blocks: Micro-CT and Analysis In Vitro

The approach employed for the site preparation of the dental implant is a variable factor that affects the implant's primary stability and its ability to integrate with the surrounding bone. The main objective of this in vitro study is to evaluate the influence of different techniques used to prepare the implant site on the primary stability of the implant in two different densities of artificial bone.

MATERIALS AND METHODS

A total of 150 implant sites were prepared in rigid polyurethane blocks to simulate two distinct bone densities of 15 pounds per cubic foot (PCF) and 30 PCF, with a 1-mm-thick simulated cortex. The implant sites were equally distributed among piezoelectric surgery (PES), traditional drills (TD), and black ruby magnetic mallet inserts (MM). Two methods have been employed to evaluate the implant's primary stability, Osstell and micro-tomography.

RESULTS

In the present study, we observed significant variations in the implant stability quotient (ISQ) values. More precisely, our findings indicate that the ISQ values were generally higher for 30 PCF compared to 15 PCF. In terms of the preparation technique, PES exhibited the greatest ISQ values, followed by MM, and finally TD. These findings corresponded for both bone densities of 30 PCF (PES 75.6 ± 1.73, MM 69.8 ± 1.91, and TD 65.8 ± 1.91) and 15 PCF (PES 72.3 ± 1.63, MM 62.4 ± 1.77, and TD 60.6 ± 1.81). By utilizing Micro-CT scans, we were able to determine the ratio of the implant occupation to the preparation site. Furthermore, we could calculate the maximum distance between the implant and the wall of the preparation site. The findings demonstrated that PES had a higher ratio of implant to preparation site occupation, followed by TD, and then the MM, at a bone density of 30 PCF (PES 96 ± 1.95, TD 94 ± 1.88, and MM 90.3 ± 2.11). Nevertheless, there were no statistically significant differences in the occupation ratio among these three approaches in the bone density of 15 PCF (PES 89.6 ± 1.22, TD 90 ± 1.31, and MM 88.4 ± 1.17). Regarding the maximum gap between the implant and the site preparation, the smallest gaps were seen when TD were used, followed by MM, and finally by PES, either in a bone density 15 PCF (PES 318 ± 21, TD 238 ± 17, and MM 301 ± 20 μm) or in a bone density 30 PCF (PES 299 ± 20, TD 221 ± 16, and MM 281 ± 19 μm). A statistical analysis using ANOVA revealed these differences to be significant, with p-values of < 0.05.

CONCLUSION

The outcomes of this study indicate that employing the PES technique and osteo-densification with MM during implant insertion may enhance the primary stability and increase the possibility of early implant loading.

Evaluation of implant site preparation with piezosurgery versus conventional drills in terms of operation time, implant stability and bone density (randomized controlled clinical trial- split mouth design)

BACKGROUND

The preparation of the implant bed has a major influence on the success rate and long-term survival of dental implants. Piezoelectric devices and special implant drilling inserts are now emerging to replace conventional drills showing improved bone response and healing around implants. The purpose of this study is to compare the piezoelectric inserts versus the traditional drills for implant site preparation.

METHODS

Twelve male patients who received a total of twenty-four dental implants have been selected to participate in this split-mouth clinical trial. Each patient received two implants; one installed after piezosurgery assisted osteotomy, while the contralateral side received the implant with the original drilling protocol. The timing of surgery, implant stability, and bone density around the installed dental implants have been evaluated during a follow-up period extended to 4 months.

RESULTS

a significant difference in terms of time of surgery (p < 0.005) and in implant stability at 4 months (p = 0.024) on the study side, while a non-statistical significance in terms of bone density was detected (p = 0.468).

CONCLUSION

The piezoelectric implant site drilling protocol seemed to be a reliable and repeatable technique. Despite the limited sample size and lengthier operative time, the piezoelectric inserts enhanced bone quality and implant stability. Clinical trial registration Current Controlled Trials (ClinicalTrials.gov) https://clinicaltrials.gov/ct2/show/NCT05512273 ; the date of registration: 23/08/2022. Retrospectively registered.

Primary implant stability based on alternative site preparation techniques: A systematic review and meta-analysis

AIM

To evaluate the effect of special implant site preparation methods in improving primary implant stability in low-density bone.

MATERIAL AND METHODS

This meta-analysis included studies published in English and Mandarin Chinese up to March 31, 2022 from MEDLINE/PubMed, Embase, Scopus, and Wanfang databases. The primary stability of five site preparation methods were measured using implant stability quotient. The random-effects model was chosen for data analysis. Grading of recommendations assessment, development, and evaluation assessment was adopted as a collective grading of the overall body of evidence.

RESULTS

12 of the 17 studies included in the meta-analysis were randomized control trials. Three studies investigated osseodensification drilling (OD), eight studies examined osteotome technique (OT), five studies explored piezosurgery (PS), and four studies were conducted on under-drilling (UD). Meta-analysis showed a statistically significant increase in primary stability for the OD (mean difference [MD], 10.25; 95% CI: 4.97-15.52; p < 0.001), OT (MD, 6.34; 95% CI: 2.26-10.42; p = 0.002), and UD (MD, 11.43; 95% CI: 5.17-17.68; p < 0.001) groups when compared to the conventional drilling group, while the PS group did not (MD, 1.50; 95% CI: -2.54-5.54; p = 0.47).

CONCLUSION

Significantly higher primary implant stability was shown in the OD, UD, and OT groups compared to the conventional drilling group. PS displayed the least favorable primary stability and when compared to conventional drilling, was not statistically significant.

Osseo-densification versus conventional surgical technique in low density jaw bone: A split mouth in vivo study

BACKGROUND: The success of dental implants depend on implant design, surgical technique, bone density, implant morphology and postoperative care. Initial stability is utmost importance and is of concern in low density bone. The osseo-densification strategy enhance primary stability by raising density of the osteotomy site walls by non-subtractive drilling, unlike conventional technique. OBJECTIVE: The aim of this in vivo study was to assess and compare the osseo-densification implant drilling technique with conventional implant drilling in terms of primary implant stability along with other factors, plaque index, bleeding on probe, pocket depth and radiographic assessment of bone density, marginal bone loss using CBCT. METHOD: A total of 20 patients aged between 40 and 59 years were included in this research. A split-mouth configuration of 40 implants was used. In the osseo-densification group, specialized (Densah) bur kit was used to insert 20 implants on one side. In the conventional group, standard bur kit was used to insert 20 implants on the opposite side of the jaw. For each patient, clinical and radiographic assessment was performed at regular intervals at the beginning (immediately after surgery), seven months, and a year following surgery. RESULTS: With the exception of bone density, which was statistically significant in favour of the osseo-densification group immediately after surgery, primary and secondary stability, plaque index, bleeding on probe, pocket depth and even marginal bone loss were not significantly different between the two groups in this investigation. CONCLUSION: Osseo-densification technique provided a better primary stability in the low density bone cases thus, can be consider as a trustworthy treatment for speeding up the healing process while also maintaining marginal bone integrity following loading. Use of specialized bur while drilling procedure improves the density around the implants.

An overview on the art of piezosurgery in the maxillofacial practice

Introduction: Piezosurgery is an emerging boom in the field of maxillofacial surgery for precise, safe and effective osteotomies sparing the adjacent vital structures compared to conventional surgery. Corpus: It works on the principle of piezoelectric effect in which crystals in the piezoelectric substances get deformed on the application of an electric field. Various studies gave the evidence of improved wound healing and bone formation compared to conventional approaches. The soft tissue sparing capability with improved patient comfort and decreased blood loss gave the utmost importance for this surgical technique in the present as well as future world of surgery. Conclusion: Piezosurgery has emerging as a promising surgical modality with a wide range of clinical applications throughout the whole field of surgery.

Stability and marginal bone loss in implants placed using piezoelectric osteotomy versus conventional drilling: systematic review and meta-analysis

Background

The main objective of this systematic review was to compare primary and secondary implant stability between placement with piezoelectric osteotomy and conventional drilling, comparing marginal bone losses as a secondary objective.

Material and Methods

An electronic search was conducted using PubMed (MEDLINE), Scopus, and Cochrane Library (Wiley) databases, besides a manual search.

Results

A total of 153 articles were retrieved, 39 from Pubmed, 44 from Scopus, and 70 from the Cochrane Library. After removing duplicates, 112 articles (1 from the manual search) were screened, and 9 were finally selected for qualitative and statistical analyses.

Conclusions

Piezoelectric surgery is a predictable alternative to conventional drilling for dental implant placement. Medium/long-term survival rates and marginal bone losses are similar between piezoelectric osteotomy and conventional drilling, and there is no difference in ISQ values for primary stability. However, implants placed with ultrasound showed a lower decrease in implant stability quotient (ISQ) during the osseointegration period and a higher ISQ value for secondary stability. This study contributes further information on peri-implant bone tissue at 3 and 6 months after implant placement with piezoelectric osteotomy or conventional drilling and provides an updated meta-analysis of comparative studies.

Key words:Piezosurgery, piezoelectric surgery, conventional drill, implant site preparation, dental implant, implant stability, marginal bone loss.

Healing at implants installed in osteotomies prepared either with a piezoelectric device or drills: an experimental study in dogs

OBJECTIVE

To compare osseointegration and marginal bone level at implants placed in osteotomies prepared with either conventional drills or a piezoelectric device.

MATERIAL AND METHODS

Three months after the extraction of all mandibular premolars and first molars, two recipient sites were selected. The osteotomies were randomly prepared with either conventional drills (drill sites) or a piezoelectric device (piezoelectric sites). Implants were installed and a submerged healing was allowed. The animals were euthanized in groups of six after 4 and 8 weeks of healing. Biopsies were obtained for histological preparation. Coronal level of osseointegration (bone level) and bone-to-implant contact percentage (BIC%) were evaluated.

RESULTS

After 4 weeks of healing, the bone level was 0.6 ± 0.9 mm for the piezoelectric sites and 1.6 ± 0.7 mm for the drill sites (p = 0.173). After 8 weeks, the respective measures were 0.9 ± 0.3 mm and 1.0 ± 1.1 mm (p = 0.917). After 4 weeks of healing, a new bone apposed onto the implant surface was found at fractions of 54.9 ± 6.7% and 55.1 ± 16.6% for the piezoelectric and the drill sites, respectively (p = 0.674). The respective total bone fractions, including new and old bone, was 64.0 ± 4.8% and 63.4 ± 20.4% (p = 0.917). After 8 weeks, a new bone increased to 67.4 ± 6.7% and 62.9 ± 12.5% for the piezoelectric and the drill sites, respectively (p = 0.463). The respective total bone fractions were 70.4 ± 5.5% and 67.8 ± 12.1% (p = 0.753).

CONCLUSIONS

The use of a piezoelectric device for implant site preparation is a safe procedure that allows a proper integration since the early periods of healing similar to that observed using conventional drills.

Evaluation of temperature and osteotomy speed with piezoelectric system

BACKGROUND

Piezosurgery is an option to realize several clinical and surgical procedures, due to its advantages as precision in osteotomy. This study aims to evaluate the heating and osteotomy speed in bone blocks of ox's shins, to report the best way of its use in the clinical practice.

METHODS

A bone blocks had the dimensions as follow: 20 mm length, 10 mm width, and 5 mm wide. It was evaluated 5 different groups: group LM (low speed and medium pressure); group HM (high speed and medium pressure); group HH (high speed and high pressure); group LH (low speed and high pressure); group LL (low speed and low pressure). The heating increasement was measured with a thermal viewer and the osteotomy was timed when the cut depth reached 5 mm and the whole block detached itself. One-way ANOVA and Tukey tests were adopted to analyze the data and the level of significance was set at a P value of 0.05.

RESULTS

The pressure and speed of the tip, works directly in the generated temperature during osteotomy. The medium pressure level is the most favorable, because high pressure level caused a high increase in heating over the bone and low pressure presented a very long osteotomy time.

CONCLUSIONS

The high speed and medium pressure can be suggested as the most efficient in both standards of time/temperature to realize the osteotomy.

Dynamics of implant site preparation affecting the quality of osseointegrated implants in the maxillary aesthetic zone

PURPOSE

This study compared piezoelectric (PE) and conventional drills (CD) for maxillary aesthetic zone implant insertion.

MATERIAL AND METHODS

This was a prospective split-mouth study. Implants were divided into two groups. Beds were prepared with CDs in group I and PE in group II. The implant stability quotient (ISQ) of the mechanical implant stability (MIS) was measured intraoperatively. The ISQ of the biological implant stability (BIS) was recorded at postoperative second and fourth months. Marginal bone loss (MBL) and bone density (BMD) were measured in the first and second years after prosthetic loading. The osteotomy time was also documented for both techniques. P values <0.05 were considered significant.

RESULTS

Sixty implants in 30 patients were included. PE provided a significantly higher ISQ. All values were above 70 throughout the follow-up period. The mean of the ISQ for MIS was 63.78 ± 1.03 and 73.89 ± 1.05 in group I and group II, respectively (p = 0.003). PE needed significantly longer osteotomy time with a mean of 11.99 ± 0.839 min. The BIS quality had high stability in group II and medium stability in group I throughout the study period. Its values decreased in both groups. Group II had a lesser percentage of decrease. However, it was significant only at time intervals between intraoperative and two months' postoperative (p = 0.004). MBL and BMD demonstrated insignificant results.

CONCLUSION

The implant site preparation with PE devices should be preferred to CDs whenever possible, because they seem to enhance implant stability and osseointegration, especially at the initial stages of healing.

Influence of Mucosal Thickness, Implant Dimensions and Stability in Cone Morse Implant Installed at Subcrestal Bone Level on the Peri-Implant Bone: A Prospective Clinical and Radiographic Study

The objective of this observational clinical study was to analyze the behavior of peri-implant tissues around cone Morse dental implants installed in the subcrestal bone position considering different clinical variables: Mucosal thickness, implant diameter, and implant length. Thirty patients were selected and included in the present study. Initially the thickness of the mucosa was measured by periapical radiographic and clinically (after the mucosal displaced). According to the planning for each treatment, implants with different dimensions (in length and diameter) were selected and used. Periapical radiographs were obtained at different times: Immediate postoperative (time t1) and 90 days after implantation (time t2). The initial stability of the implants (ISQ) was measured immediately of the implant insertion and 90 days after. The means and standard deviations of the ISQ values were in time t1 was 63.2 ± 6.99 (95% confidence interval (CI): 41 to 83) and in time t2 was 69.7 ± 7.09 (95% CI: 61 to 87). Overall mean of mesial and distal bone loss 90 days after the implantations were 1.11 ± 1.16 mm and 1.11 ± 1.15 mm, respectively. When the variables were considered, in all situations proposed, the bone loss showed differences statistically significant. In conclusion, the implant diameter and mucosal thickness variables showed an important effect on bone loss values. However, the implant length did not show an effect on the peri-implant behavior.

Immediate Loading of Implant-Supported Single Crowns after Conventional and Ultrasonic Implant Site Preparation: A Multicenter Randomized Controlled Clinical Trial

Aim

To compare implant survival rate and marginal bone loss (MBL) of immediately loaded single implants inserted by using ultrasonic implant site preparation (UISP) (test) and conventional rotary instrumentation (control).

Methods

Two single implants were inserted for each patient: after randomization, test site was prepared by using an ultrasonic device (Piezosurgery Touch, Mectron, Italy) and control site was prepared by using the drills of the selected implant system (Premium AZT, Sweden & Martina, Italy), until reaching a final diameter of 3 mm in both groups. Identical implants (3.8x11.5 mm) were inserted in all sites at crestal level. Impressions were taken and screwed resin single crowns with platform-switched provisional abutments were delivered with 48 hours. Periapical radiographs were taken at provisional crown insertion (T0), 6 months (T1) and one year (T2) after prosthetic loading to measure MBL. All data were tested for normality and subsequently analyzed by paired samples t-test and forward multiple linear regression.

Results

Forty-eight patients were treated in six centers with the insertion of ninety-six implants (48 test; 48 control). Four implants in four patients failed within the first six months of healing (two in test group; two in control group; no difference between groups). Forty patients (age 60.1±10.7 years; 22 female, 18 male) were included in the final analysis. Mean MBL after six months of loading was 1.39±1.03 mm in the test group and 1.42±1.16 mm in the control group (p>0.05) and after one year was 1.92±1.14 mm and 2.14±1.55 mm in test and control, respectively (p>0.05).

Conclusions

No differences in survival rate and MBL were demonstrated between UISP and conventional site preparation with rotary instruments in immediately loaded dental implants: UISP, with its characteristics of enhanced surgical control and safety in proximity of delicate structures, may be used as a reliable alternative to the traditional drilling systems.

Retracted: A new cervical implant design compared with standard design in order to increase peri-implant hard and soft tissue behavior: histomorphometric and histological study in dogs

OBJECTIVE

The aim of this study was to evaluate a new design of the cervical portion of dental implant with the objective to increase the volume of peri-implant tissues in the crestal area.

MATERIALS AND METHODS

Forty-eight tapered dental titanium implants with internal conical connection were implanted in healed alveolar sites of six dogs. Twenty-four conventional implants design (C1 implant) formed the control group, and 24 new implant design (V3 implant) formed the test group. The groups were randomized. Histological, histomorphometric, and implant stability quotient were performed. After 12 weeks of healing period, histomorphometric analyses of the specimens were carried out to measure the crestal bone level values and the tissue thickness in the cervical implant portion. The data were compared using statistical tests (α = 5%).

RESULTS

The mean of the measurements in the buccal and lingual aspects measured of crestal bone level was 0.31 ± 0.24 mm and 0.30 ± 0.19 mm in the control group, respectively, and 0.71 ± 0.28 and 0.42 ± 0.30 mm in the test group, respectively, whereas the mean of the tissue thickness was 1.63 ± 0.33 mm and 2.04 ± 0.23 mm in the control group, respectively, and 2.11 ± 0.35 mm and 2.51 ± 0.41 mm in the test group.

CONCLUSIONS

Within the limitations of this study, our findings suggest that more thickness of peri-implant hard and soft tissues may be expected in this new implant design. However, the control group with traditional implant design was found to have more height values of the crestal bone compared with new V3 implants.

Peri-Implant Bone Behavior after Single Drill versus Multiple Sequence for Osteotomy Drill

Objectives

The present study aims to compare the drilling protocol effect on osseointegration event in three commercially available titanium dental implants with different drill protocol using a rabbit tibia model.

Materials and Methods

Three different drilling sequences were compared as follows: drilling sequence using a single unique drill of 4.2 mm conical implant (Group 1), drilling sequence using 3 consecutive cylindrical drills for a 4.1 mm cylindrical implant (Group 2), and drilling sequence using 3 consecutive conical drills for a 4.3 mm conical implant (Group 3). For each group, 18 drilling procedures and implant placements were performed, totalizing 54 commercially available titanium dental implants. The samples were removed 6 weeks after implantation. Resonance frequency analyses (RFA) were performed immediately after the implantation, and at 6 weeks removal torque test (RTt) and histological analysis were performed.

Results

The RFA measured showed statistical difference between the groups in time 1 and no significant statistical differences in time 2 (p > 0.05). In the RTt no significant difference was found between the 3 groups tested. Histomorphometric analysis showed no significant difference between groups in the bone-to-implant contact% (p > 0.05).

Conclusion

In the present preclinical study, osteotomy using a single bur did not show differences regarding the proposed and evaluated tests parameters for assessing the peri-implant behavior.

Piezoelectric versus conventional implant site preparation: A systematic review and meta-analysis

BACKGROUND

The use of a piezoelectric device (PED) for implant site preparation (ISP) has been introduced to overcome the limitations of using conventional drills (CDs). With little and inconsistent information in the literature regarding their efficiency for preparing implant osteotomies, the objective of this systematic review was to compare the use of CDs to PEDs for ISP with regard to implant stability values, marginal bone level changes, operating time, and dental implant failure rate.

METHODS

The systematic review was prepared according to the guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). The literature was searched for studies that assessed the use of CDs and PEDs for ISP. The Cochrane Collaboration risk of bias tool was used to evaluate the selected studies and meta-analyses were performed using statistical software.

RESULTS

A total of 755 citations were identified. Of these, 4 studies with 178 implant osteotomies in 80 participants were included. The pooled estimates for the implant stability showed significant differences between the 2 surgical techniques in favor of PEDs at baseline, 8 and 12 weeks. A statistically significant difference in the operating time was also shown between the 2 techniques with more time required using PED. The differences in marginal bone level changes or implant failure rate were not statistically significant.

CONCLUSIONS

With the limitations of this review in mind, PEDs appear to be a viable alternative to traditional drilling techniques for ISP. With the exception of prolonged operating time associated with the use of PEDs, both techniques were comparable in terms of the marginal bone level changes and the risk of implant failure. The favorable influence of the implant stability pattern related to the use of PEDs on the predictability of immediate and early loading protocols need to be confirmed in future studies.

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.

Does Mixed Conventional/Piezosurgery Implant Site Preparation Affect Implant Stability?

The aim of this study was to compare the effect of conventional implant site preparation technique and a combination of conventional/piezosurgery preparation on implant stability measured at different time intervals, insertion torque, and preparation time. A randomized controlled study was designed, it included 26 patients who received 54 dental implants randomly assigned to 2 groups; in the control group, implants were installed after conventional preparation with drills whereas the study group received implants after mixed conventional/piezosurgery preparation. The outcome variables included: implant stability measured immediately after implant insertion, at 8 weeks and 16 weeks postoperatively, insertion torque and preparation time. All the investigated variables were analyzed statistically using 1 sample Kolmogrov-Simirenov test, Mann-Whitney U test, paired and unpaired Student t test, the Pearson χ test, Fisher exact test, and analysis of variance (1-way ANOVA). The differences were considered significant at P ≤ 0.05. Implant stability showed a similar pattern in both the groups which consists of a statistically significant decrease in implant stability quotient values at the 8th week followed by a statistically significant increase at the 16th week, where the implant stability quotient values return close to those of primary stability. The 2 groups revealed a statistically not significant difference in insertion torque and implant stability changes throughout the study period, whereas the preparation time was significantly longer in the study group than the control group. The mixed conventional/piezosurgery method of implant site preparation offers no additional advantage over the conventional drilling method in terms of values of insertion torque and patterns of implant stability change throughout the healing period.

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.

Factors Affecting Dental Implant Stability Measured Using the Ostell Mentor Device: A Systematic Review

OBJECTIVES

The aim of this study was to review the literature on factors that may affect dental implant stability as measured with the Ostell mentor device.

MATERIALS AND METHODS

A systematic search of the literature was performed in Pubmed, Scopus, and Cochrane databases using dental implants, stability, and resonance frequency analysis as key words.

RESULTS

The most relevant randomized controlled trials and clinical trials (n = 39) were selected from among 264 articles.

CONCLUSIONS

Many factors can affect dental implant stability as measured with the Ostell mentor device. This may be a useful instrument for deciding the timing of implant loading, but additional research is required to establish the reliability and predictability of resonance frequency analysis for the future osseointegration of dental implants, which remains controversial.

Rotary Instrument or Piezoelectric for the Removal of Third Molars: a Meta-Analysis

AIM

The aim of this systematic review and meta-analysis was to compare, in the lower third molar surgery, the osteotomy techniques with rotary instruments and piezoelectric motors.

METHODS

An electronic search was conducted using the following databases: Pubmed, Web of Science, and the Cochrane Oral Health Group Trials Register. Inclusion criteria were: studies in humans, randomized or nonrandomized, comparing the extraction of third molars that required osteotomy and/or odontosection with rotary instrument and osteotomy and/or odontosection with piezoelectric motor assistance. The analysis and inclusion of articles was performed by two reviewers independently. An evaluation of the quality of articles and data extraction was carried out.

RESULTS

From a total of nine hundred seventy four (974) trials, eleven articles were included in the qualitative analysis, and seven were included in the quantitative analysis. Rotary instruments were faster than the piezoelectric surgery (95 % CI 0.34 to 1.16). The piezoelectric surgery showed better results when compared with roatry instruments when trismus was assessed in 2 (95 % CI 0.65 to 1.69), 3 (95 % CI 0.63 to 1.67) and 5 (95 % CI 0.03 to 2.26) days after surgery. Seven days after surgery, there were no differences between the techniques (95 % CI (-0.022) to (-1.49)).

CONCLUSION

The piezoelectric surgery was effective in reducing pain, swelling and trismus in third molar surgery, but the same requires greater surgical time than the rotary instruments.

Effects on the osseointegration of titanium implants incorporating calcium-magnesium: a resonance frequency and histomorphometric analysis in rabbit tibia

OBJECTIVE

This study assessed the bone formation around titanium surface incorporating the calcium-magnesium (CaMg) deposited by blasted in rabbit tibia bone to determine whether this surface would further enhance bone healing compared with commercially available implant surface.

MATERIAL AND METHODS

The deposition of CaMg on the titanium SLA surface were obtained by blasting formed the experimental group (EX group), while implants with traditional SLA surface were used as control group (CO group), in this study. Fifty cylindrical threaded implants with a length of 8 mm were used (P = 25 per group). Five implants of each group were used to surface characterization by scanning electron microscopy, energy dispersive spectrometry, and optical profilometry. Ten New Zealand white rabbits received 40 implants (n = 20 per group). Resonance frequency analysis was performed three times (0, 4, and 6 weeks). Histomorphometric analysis was performed 4 and 6 weeks after implantation. Statistical significance was set at P < 0.05.

RESULTS

Blasted CaMg deposition on SLA implant surface displayed almost identical surface morphologies and R(a) values at the micron scale. In comparing the implant stability quotient at the three time points, highly significant statistic differences were found (P < 0.001). Histomorphological analysis showed higher degrees of bone organization in the samples of test implant surfaces at both implantation times.

CONCLUSION

Within the limitations of this study, the results indicate that the deposition of CaMg on the SLA titanium surface may be effective in enhancing the osseointegration of moderately rough grit-blasted implants by increasing the degree of bone-implant contact.

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.

Temperature Values Variability in Piezoelectric Implant Site Preparation: Differences between Cortical and Corticocancellous Bovine Bone

Purpose. Various parameters can influence temperature rise and detection during implant site preparation. The aim of this study is to investigate local temperature values in cortical and corticocancellous bovine bone during early stages of piezoelectric implant site preparation. Materials and Methods. 20 osteotomies were performed using a diamond tip (IM1s, Mectron Medical Technology, Carasco, Italy) on two different types of bovine bone samples, cortical and corticocancellous, respectively. A standardized protocol was designed to provide constant working conditions. Temperatures were measured in real time at a fixed position by a fiber optic thermometer. Results. Significantly higher drilling time (154.90 sec versus 99.00 sec; p < 0.0001) and temperatures (39.26°C versus 34.73°C; p = 0.043) were observed in the cortical group compared to the corticocancellous group. A remarkable variability of results characterized the corticocancellous blocks as compared to the blocks of pure cortical bone. Conclusion. Bone samples can influence heat generation during in vitro implant site preparation. When compared to cortical bone, corticocancellous samples present more variability in temperature values. Even controlling most experimental factors, the impact of bone samples still remains one of the main causes of temperature variability.

Evaluation of the Cortical Bone Reaction Around of Implants Using a Single-Use Final Drill: A Histologic Study

OBJECTIVES

This study was designed to compare the cortical bone reaction following traditional osteotomy or the use of a single-use final drill in the osseointegration of implants in the tibia of rabbits.

MATERIALS AND METHODS

For this study, 48 conical implants, of standard surface type and design and manufactured by the same company, were inserted into the tibiae of 12 rabbits and removed after 30 or 60 days for histologic analysis. Two test groups were prepared according to the drill sequence used for the osteotomy at the preparation sites: in the control group was used a conventional drill sequence with several uses, whereas the test group (tesG) used a single-use final drill. The bone-to-implant contact and qualitative factors of the resulting cortical bone were assessed.

RESULTS

Both techniques produced good implant integration. Differences in the linear bone-to-implant contact were observed between the drilling procedures as time elapsed in vivo, with the tesG appearing to have clinical advantages. Both groups exhibited new bone in quantity and in quality; however, the tesG exhibited a higher level of new bone deposition than the control group.

CONCLUSIONS

Within the limitations of this study, the findings suggest that the use of a single-use final drill leads to better and faster organization of the cortical bone area during the evaluated period and may avoid the possible problems that can be caused by worn drills.

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.

The influence of three different apical implant designs at stability and osseointegration process: experimental study in rabbits

OBJECTIVES

The aim of this study was to perform a histomorphometric and biomechanical comparison of three implants with different designs of the apical area to promote a better bone initial stability and its correlation with the osseointegration.

MATERIAL AND METHODS

Fifty-four tapered implants with same length, diameter and surface properties but with three different apical configurations (Group I: MK4: Group II: C1 and Group III: MK7) were inserted in the tibia of rabbits. Implant stability and bone formation were evaluated by resonance frequency analysis measured at 0, 6, 8 and 12 weeks and by histomorphometric analysis performed at 6, 8 and 12 weeks.

RESULTS

Statistical test to compare the stability through the implant stability quotient in the four times showed few differences between the groups and time periods proposed, with significance set at P < 0.05. In the bone-implant contact, by comparing the groups in the three times proposed, it was possible concluded that there is a similar behavior among the three implant design (P < 0.05).

CONCLUSION

With the limitations of this animal study, it can be concluded that the design of the apical area influences the implant stability and the bone-to-implant contact.

Piezosurgery in implant dentistry

Piezosurgery, or the use of piezoelectric devices, is being applied increasingly in oral and maxillofacial surgery. The main advantages of this technique are precise and selective cuttings, the avoidance of thermal damage, and the preservation of soft-tissue structures. Through the application of piezoelectric surgery, implant-site preparation, bone grafting, sinus-floor elevation, edentulous ridge splitting or the lateralization of the inferior alveolar nerve are very technically feasible. This clinical overview gives a short summary of the current literature and outlines the advantages and disadvantages of piezoelectric bone surgery in implant dentistry. Overall, piezoelectric surgery is superior to other methods that utilize mechanical instruments. Handling of delicate or compromised hard- and soft-tissue conditions can be performed with less risk for the patient. With respect to current and future innovative surgical concepts, piezoelectric surgery offers a wide range of new possibilities to perform customized and minimally invasive osteotomies.

Morphological characteristics of osteotomies using different piezosurgical devices. A scanning electron microscopic evaluation

PURPOSE

The objective of this study was to compare morphological characteristics of osteotomies performed by 6 Piezosurgical devices.

MATERIALS AND METHODS

The 6 Piezosurgical units were: (a) Piezotom, (b) SurgySonic, (c) Piezon Master Surgery, (d) VarioSurg, (e) Surgybone, and (f) Piezosurgery 3. Osteotomies on 9 freshly slaughtered cattle ribs (2 cuts by each unit, per rib) from the cortical (first cut at 5 mm) to the cancellous (second cut at 3 mm) bone layer were performed. The osteotomy margins were compared using scanning electron microscopy analysis. The cutting areas, osteotomy bottoms, and osteotomy margins were analyzed morphologically. Statistical evaluation of the 2 cuts regarding the design of the tips (a-d: tapered tool shanks, f: parallel tool shank) was performed by an unpaired t test.

RESULTS

Morphological characteristics were different for each Piezosurgical unit and each examined area. A significant difference (P = 0.0209) of the upper width of the first cut between tapered and parallel tips was shown.

CONCLUSIONS

The morphological characteristics of the produced Piezosurgical osteotomies vary and depend on the Piezosurgical unit and tip.

The effect of piezoelectric surgery implant osteotomy on radiological and molecular parameters of peri-implant crestal bone loss: a randomized, controlled, split-mouth trial

AIM

To evaluate the effect of piezoelectric surgery (PS) implant osteotomy on biochemical and radiological parameters of crestal bone (CB) loss.

MATERIAL AND METHODS

In this randomized, controlled, clinical study, 38 osteotomies were prepared with PS and drilling in the posterior maxilla in a split-mouth design. Implants were placed and left for non-submerged healing. Osteotomy time, insertion torque, pain perception, probing depth, and modified gingival and plaque indices were recorded. Peri-implant sulcular fluid (PISF) was collected from four sites of each implant at 2, 4, 8, 12, and 24 weeks. PISF samples were analyzed by ELISA for receptor activator of nuclear factor kappa-B-ligand (RANKL) and osteoprotegerin. CB loss was assessed on periapical radiographs at the 12th and on cone beam computed tomography (CBCT) at the 24th weeks. The influence of time and osteotomy method on biochemical and radiological parameters of CB loss employed statistical method of Brunner-Langer.

RESULTS

Osteotomy time for PS group was significantly longer than the drill group (P < 0.05). Pain perception that was lower in the PS than in the drill group depended on osteotomy method (P < 0.05). PS group had lower RANKL total amount than the drill group (P < 0.05). Mean CB loss on periapical radiographs at the 12th week for PS and drill groups were 0.11 and 0.18 mm, respectively (P > 0.05). At the 24th week, PS and drill groups showed 0.11 and 0.12 mm CB losses on CBCT, respectively (P > 0.05). However, CB loss values did not depend on osteotomy modality (P > 0.05).

CONCLUSION

PS may modify and reduce bone-destructive inflammatory response during implant osseointegration. Therefore, on the molecular level, it might be a less traumatic osteotomy modality than drilling although this was not reflected by CB loss values in the present study.

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.