Effects of osseodensification protocol on insertion, removal torques, and resonance frequency analysis of BioHorizons® conical implants. An ex vivo study

Ridge dimensional changes and implant stability utilizing the osseodensification protocol: A randomized clinical trial

BACKGROUND

There is limited evidence on the effect of osseodensification drilling (OD) on alveolar ridge dimension changes and implant stability compared to standard drilling (SD). The purpose of this study was to compare the effect of both drilling protocols on ridge dimensional changes and implant stability.

METHODS

Fifteen patients were recruited for a total of 20 pairs of implants. Pre- and postdrilling ridge widths were measured at the crest and 5 and 10 mm apical to the crest, using a premarked surgical guide as a reference to standardize recordings. Following implant placement, insertion torque and implant stability quotients (ISQ) were recorded. ISQ were also recorded at 3, 6, and 12 weeks post-op. Six-month post-op changes in buccal bone thickness (BBT) were measured via pre-op and post-op cone beam computed tomography (CBCT) superimposition analysis.

RESULTS

Greater ridge width changes were observed at the crest and 5 mm apical from the crest, favoring OD, with no difference at 10 mm. When comparing BBT 6 months post-op, OD maintained BBT better than SD. Additionally, greater insertion torque, ISQ, and high implant stability (HIS) were observed following OD compared to SD.

CONCLUSION

OD results in greater ridge dimensional changes compared to SD following osteotomy preparation, predictably maintains BBT and reduces the risk of buccal dehiscence and resorption, obtains superior torque at placement, higher ISQ values, and a greater number of implants achieving HIS, which is maintained throughout the entire healing period.

A Comparison of Different Implant Site Preparation Techniques in Low-Density Bone: An Ex-Vivo Study

INTRODUCTION

Osseointegration is considered a prerequisite for the long-term success of dental implants, and many researchers have considered the stability of the implant when placed in the bone. Many techniques include undersized drilling, densifying burs, magnetic mallets, and expanders. These methods have led to higher initial insertion torque values. The present study aims to evaluate the effectiveness of expanders, densifying burs, and magnetic mallet methods for preparing the implant site in low-density bone and compare them in terms of achieving good initial implant stability.

MATERIALS AND METHODS

The present study was conducted in an ex vivo animal model using bovine rib bones. This study was performed on 20 bovine ribs; each rib had four implant site preparations divided into four groups according to the drilling method: a control group of the conventional technique (n=20), the expanders group (n=20), the densification burs group (n=20), and the magnetic mallet group (n=20). The measured values were Primary Insertion Torque and Implant Stability Quotient (ISQ).

RESULTS

The highest average insertion torque was in the magnetic Mallet group, where the average was 43.75 N/cm2, followed by the burs group, where the average was 43.00 N/cm2, then the expanders group with an average of 32.80 N/cm2, then the conventional preparation group with 19.30 N/cm2 as the lowest average among the study groups. The highest ISQ mean was in the burs group, where the mean was 80.30, followed by the magnetic Mallet group, where the mean was 80.20, then the expanders group with a mean of 68.90, then the conventional preparation group with 50.10 as the lowest mean among the study groups.

CONCLUSION

Within the limitation of this study, we conclude that all methods used were better than conventional preparation in both ISQ and insertion torque, with the magnetic mallet group outperforming the insertion torque and the Densah burs outperforming the ISQ.

Effects of Osseodensification on Primary Stability of Cylindrical and Conical Implants-An Ex Vivo Study

Primary stability is an important factor for dental implant success. In the past years, a new method for bone site preparation was introduced, named osseodensification (OD). OD produces a condensation of the trabecular portion of the bone, increasing bone-to-implant contact and primary stability. This study aims to compare the effect of OD in cylindrical and conical implants to conventional instrumentation. A total of forty implants, divided into four groups, were placed in porcine tibia: cylindrical conventional (1a), cylindrical OD (1b), conical conventional (2a) and conical OD (2b). Each implant was measured for implant stability quotient (ISQ), insertion torque (IT) and removal torque (RT). Group 2b showed the higher values for each of the evaluated parameters; groups 1b and 2b showed better results than 1a and 2a, respectively. Regarding the IT and RT, group 1b achieved higher values than group 2a, but not for ISQ. The inter-group comparison showed significant difference between groups 1a vs 2a, 1a vs 2b and 1b vs 2b for ISQ and 1a vs 1b and 1a vs 2b for RT analysis. OD resulted in improved ISQ, IT and RT of both cylindrical and conical implants.

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.

The Effect of Under-Drilling and Osseodensification Drilling on Low-Density Bone: A Comparative Ex Vivo Study

The aim of this study is to identify a method that can maximize implant primary stability (IPS) and bone density under the controlled drilling conditions of the same diameter and length in low-density bones through an ex vivo study. A total of 87 dental implants were placed with standard drilling, under-drilling, and osseodensification drilling in 13 fresh porcine sternums. The Periotest value and the implant stability quotient were measured to evaluate the primary stability. The difference in the Hounsfield unit (HU) between the hole and peripheral bone up to a distance of 1 mm was measured. Osseodensification and under-drilling technique increased the IPS, compared with conventional drilling technique with statistical significance under the drilling conditions of the same diameter and length. Osseodensification technique with the counter-clockwise direction had higher HU gaps than the standard drilling and osseodensification technique with clockwise direction. Due to the effect of bone densification, the gap of HU was increased by a minimum of 43 HU and a maximum of 180 HU. Within the limitations of this ex vivo study, it was found that the osseodensification technique with counter-clockwise direction is effective to increase IPS and bone mineral density in low-density bone.