Relation Between Insertion Torque and Implant Stability Quotient: A Clinical Study

Jamil F, M. AL-Anee A, Jassim Muhsen S. Relationship Between the Level of Vitamin D3 Deficiency and Successful Osseointegration: A Prospective Clinical Study

Purpose: This study aimed to evaluate the influence of vitamin D3 levels on bone density, primary dental implant stability, and successful osseointegration. Materials and Methods: Clinical and radiological examination with a standardized cone-beam computed tomography (CBCT) machine and laboratory investigation for serum levels of vitamin D3 were performed for all patients. Only patients in need of single or multiple straightforward dental implant surgery in either jaw with no history of systemic disease or condition that may interfere with bone healing were included in this study to receive the dental implant by the same oral and maxillofacial surgeon, which re-opened 4 months later to assess the osseointegration and to complete the prosthetic part. Results: One hundred twenty-eight dental implants were inserted into 108 patients. Most of the patients in the study had insufficient vitamin D3 levels. The prognosis of dental implants regarding successful osseointegration 4 months after implant placement had a weak positive association with the insertion torque and bone mineral density and a statistically significant positive correlation with the serum vitamin D3 level. Conclusion: Preoperatively, it is advisable to request the serum vitamin D3 level of the patients along with the standard clinical and radiological examination. Severe vitamin D3 deficiency could be associated with early dental implant failure despite the favorable bone density and primary dental implant stability achieved. Trial Registration: ClinicalTrials.gov identifier: TCTR20200304001.

What Is the Survival Rate of Implants Loaded Immediately with a Branemark Protocol Prosthesis? A Review

The aim of this review was to determine the survival rate of implants loaded immediately with a Branemark protocol prosthesis. An electronic search was performed in the PubMed/MEDLINE database from 2006 to February 2024, using a combination of Medical Subject Headings descriptors: "completely edentulous" and "immediate loading." Human clinical articles in English that evaluated the survival rate of implants loaded immediately with a Branemark protocol prosthesis after placement in the bone were included. A total of 546 articles were identified, of which 15 were included in this study. The 15 articles included in the literature showed a high implant survival rate (more than 93%) after immediate loading.

Influence of torque and bone type on stability quotient of two implant platforms: a clinical trial

The objective of this study was to analyze the influence of insertion torque, bone type, and peri-implant bone loss on implant stability quotient (ISQ) of cylindrical external hexagon (EH) and Morse Taper (MT) implants. Forty-four single implants were placed in the edentulous areas of 20 patients who met the inclusion and exclusion criteria. Immediately after implant placement (t1) and after osseointegration (four and six months for mandible and maxilla, respectively) (t2), insertion torque, resonance frequency, and peri-implant bone loss were measured using probing depths and digital periapical radiography. A significant difference was noted in the ISQ values between t1 and t2 in type III bone for EH and MT implants. No significant difference in bone loss values was observed when comparing bone types for EH or MT in all evaluated sites. Based on marginal bone loss assessed using radiography, there was no significant difference between the MT and EH groups. A positive correlation between torque and ISQ t1 value was observed for MT (correlation: 0.439; p = 0.041) and EH (correlation: 0.461; p = 0.031) implants. For EH and MT implants, the greater the insertion torque, the greater was the ISQ value (moderately positive correlation). A weak negative correlation was found between bone type and ISQ t1 for MT implants. Contrarily, no correlation was observed between bone type and ISQ t1 for EH implants. In all cases, bone loss around the implants was clinically normal.

The Effectiveness of Osseodensification Drilling versus the Conventional Surgical Technique on Implant Stability: A Clinical Trial

Background/Objective: To ensure that implants are able to support prosthetic rehabilitation, a stable and functional union between the bone and the implant surface is crucial to its stability and success. To increase bone volume and density and excel bone-implant contact, a novel drilling method, called osseodensification (OD), was performed. To assess the effectiveness of the osseodensification drilling protocol versus the conventional surgical technique on implant stability. Methods: Bone Level Tapered Straumann implants were placed side-by-side with both OD and subtractive conventional drilling (SD) in 90 patients from CESPU-Famalicão clinical unit. IT was measured using a manual torque wrench, and the Implant stability quotient (ISQ) value was registered using the Osstell® IDX. Results: According to the multifactorial ANOVA, there were statistically significant differences in the mean IT values due to the arch only (F(1.270) = 4.702, p-value = 0.031 < 0.05). Regarding the length of the implant, there were statistically significant differences in the mean IT in the OD group (p = 0.041), with significantly lower mean IT values for the Regular implants compared to the Long. With respect to the arch, the analyses of the overall ISQ values showed an upward trend in both groups in the maxilla and mandible. High levels of IT also showed high ISQ values, which represent good indicators of primary stability. Conclusions: OD does not have a negative influence on osseointegration compared to conventional subtractive osteotomy.

Pre-implantation teriparatide administration improves initial implant stability and accelerates the osseointegration process in osteoporotic rats

PURPOSE

Osteoporotic individuals who have dental implants usually require a prolonged healing time for osseointegration due to the shortage of bone mass and the lack of initial stability. Although studies have shown that intermittent teriparatide administration can promote osseointegration, there is little data to support the idea that pre-implantation administration is necessary and beneficial.

METHODS

Sixty-four titanium implants were placed in the bilateral proximal tibial metaphysis in 32 female SD rats. Bilateral ovariectomy (OVX) was used to induce osteoporosis. Four major groups (n = 8) were created: PRE (OVX + pre-implantation teriparatide administration), POST (OVX + post-implantation administration), OP (OVX + normal saline (NS)) and SHAM (sham rats + NS). Half of rats (n = 4) in each group were euthanized respectively at 4 weeks or 8 weeks after implantation surgery, and four major groups were divided into eight subgroups (PRE4 to SHAM8). Tibiae were collected for micro-CT morphometry, biomechanical test and undecalcified sections analysis.

RESULTS

Compared to OP group, rats in PRE and SHAM groups had a higher value of insertion torque (p < 0.05). The micro-CT analysis, biomechanical test, and histological data showed that peri-implant trabecular growth, implants fixation and bone-implant contact (BIC) were increased after 4 or 8 weeks of teriparatide treatment (p < 0.05). There was no statistically difference in those parameters between PRE4 and POST8 subgroups (p > 0.05).

CONCLUSIONS

In osteoporotic rats, post-implantation administration of teriparatide enhanced peri-implant bone formation and this effect was stronger as the medicine was taken longer. Pre-implantation teriparatide treatment improved primary implant stability and accelerated the osseointegration process.

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.

Influence of a specially designed geometric device and modified scan bodies on the accuracy of a maxillary complete arch digital implant scan: An in vitro study

STATEMENT OF PROBLEM

Capturing accurate complete arch digital implant scans remains a challenging process because of the lack of recognizable anatomic landmarks. The effect of modified scan bodies (SBs) on improving scanning accuracy is unclear.

PURPOSE

The purpose of this in vitro study was to evaluate and compare the accuracy of a maxillary complete arch digital implant scan when using a specially designed geometric device with the accuracy of modified scan bodies.

MATERIAL AND METHODS

Four implants were placed in an edentulous maxillary model made of porous bone material with polyurethane attached gingiva. Scan bodies were attached to the implants and then digitized with a high precision laboratory scanner to create the reference scan. Round depressions were made on the buccal and palatal surfaces of the scan bodies, and the model was scanned with an intraoral scanner using 4 different scenarios: the model with no geometric device or modified scan bodies (ND-NM), device only without modified scan bodies (D-NM), no device but with modified scan bodies (ND-M), and device with modified scan bodies (D-M). Each group was scanned 10 times for a total of 40 scans. Trueness and precision were evaluated using inspection software to measure the 3D surface deviation. Trueness was measured by superimposing each test scan on the reference scan, and precision was calculated by superimposing the test scans of the same group with each other. Data were analyzed using the GraphPad Prism version 8.0.0 software program. Two-way ANOVA was performed to assess the effect of the device and modifications on trueness and precision (α=.05).

RESULTS

Both the geometric device and SB modifications had a significantly significant effect on trueness and precision (P<.001). Regarding trueness, group D-M had the lowest mean and standard deviation (0.158 ±0.028 mm) in contrast with group ND-NM, which had the highest deviation (0.282 ±0.038 mm). In terms of precision, group D-M showed the lowest mean and standard deviation (0.134 ±0.013 mm), while group ND-NM revealed the highest deviation (0.222 ±0.031 mm). However, no statistically significant interaction was found between the device and modifications regarding either trueness or precision (P>.05).

CONCLUSIONS

Using a specially designed geometric device improved both the trueness and precision of complete arch digital implant scans. The modified SBs had a positive influence on the scanning trueness and precision, and the best accuracy was achieved when using the geometric device and the modified SBs simultaneously.

"Compression Necrosis" - A Cause of Concern for Early Implant Failure? Case Report and Review of Literature

Purpose

Compression necrosis refers to bone tissue damage that can occur when excessive pressure or force is applied to surrounding bone during implant placement. This pressure can compromise blood supply to the bone, leading to necrosis. Compression necrosis is a concern, because it can affect the stability and long-term success of dental implant.

Patients and Methods

This case report highlights a case of early bone loss and implant failure possibly due to compression necrosis. Clinical data, photographs, radiographs, blood examination report and histology were presented to document the early failure of an implant placed in the mandibular left posterior region of a 33-year-old female patient.

Results

Radiograph taken six weeks after implant placement showed severe angular defect. Therefore, the implant was surgically removed. Histological examination of the area showed bony trabeculae with an absence of osteoblastic riming, suggestive of necrotic bone.

Conclusion

Using excessive torque values when placing implants in dense bones can increase the risk of implant failure due to bone over compression. Dental professionals must follow the manufacturer's instructions and employ quality surgical techniques during implant placement into dense cortical bone to minimise risks.

Correlation between Periotest value and implant stability quotient: a systematic review

OBJECTIVES

To determine, through clinical studies, whether there is a correlation between the Periotest value (PTV) and the implant stability quotient (ISQ).

CONTENT

Methods to evaluate the stability of dental implants.

SUMMARY

A search was performed in the PubMed, Scopus, and Web of Science databases for articles on the proposed subject up to January 29, 2023, using search terms that combined "resonance frequency analysis" and "Periotest" with "correlation" or "relationship"; and combinations of "implant stability quotient" and "Periotest" with "correlation" or "relationship." The inclusion criteria were clinical studies in English involving human subjects who received dental implants and evaluating the correlation between PTV and ISQ. A total of 46 articles were screened, of which 10 were selected for full-text analysis, and eight articles were included in this review. Based on three articles, 75 % of the results of this systematic review showed a negative correlation between PTV and ISQ, regardless of the type of stability assessed. Based on the remaining five articles, 100 % (regardless of the patient's gender) and 66.66 % of the results showed a negative correlation for primary and secondary stability, respectively. There is a negative correlation between PTV and ISQ for both primary and secondary dental implant stability.

OUTLOOK

This review can serve as a reference for the development of methodologies for future clinical studies on this topic.

The influence of truncated-conical implant length on primary stability in maxillary and mandibular regions: an in vitro study using polyurethane blocks

OBJECTIVES

This in vitro study is aimed at assessing whether implant primary stability is influenced by implant length in artificial bone with varying densities.

MATERIALS AND METHODS

A total of 120 truncated-conical implants (60 long-length: 3p L, 3.8 × 14 mm; 60 short-length: 3p S, 3.8 × 8 mm) were inserted into 20, 30, and 40 pounds per cubic foot (PCF) density polyurethane blocks. The insertion torque (IT), removal torque (RT), and resonance frequency analysis (RFA) values were recorded for each experimental condition.

RESULTS

In 30 and 40 PCF blocks, 3p S implants exhibited significantly higher IT values (90 and 80 Ncm, respectively) than 3p L (85 and 50 Ncm, respectively). Similarly, RT was significantly higher for 3p S implants in 30 and 40 PCF blocks (57 and 90 Ncm, respectively). However, there were no significant differences in RFA values, except for the 20 PCF block, where 3pS implants showed significantly lower values (63 ISQ) than 3p L implants (67 ISQ) in both the distal and mesial directions.

CONCLUSIONS

These results demonstrated that the implant's length mainly influences the IT and RT values in the polyurethane blocks that mimic the mandibular region of the bone, resulting in higher values for the 3p S implants, while the RFA values remained unaffected. However, in the lowest density block simulating the maxillary bone, 3p L implants exhibited significantly higher ISQ values.

CLINICAL RELEVANCE

Therefore, our data offer valuable insights into the biomechanical behavior of these implants, which could be clinically beneficial for enhancing surgical planning.

Randomized Clinical Trial Comparing Insertion Torque and Implant Stability of Two Different Implant Macrogeometries in the Initial Periods of Osseointegration

Objectives: The present study compared two implants with different macrogeometries placed in healed alveolar sites, evaluating the insertion torque (ITV) and implant stability quotient (ISQ) values at three different periods. Methods: Seventy patients with a total of 100 dental implants were allocated into two groups (n = 50 per group): DuoCone implants (DC group) that included 28 implants in the maxilla and 22 in the mandible, and Maestro implants (MAE group) that included 26 in the maxilla and 24 in the mandible. The ITV was measured during the implant placement, and the ISQ values were measured immediately at implant placement (baseline) and after 30 and 45 days. Results: The mean and standard deviations of the ITV were statistically significant (p < 0.0001), 56.4 ± 6.41 Ncm for the DC group and 29.3 ± 9.65 Ncm for the MAE group. In the DC group, the ISQs ranged between 61.1 ± 3.78 and 69.8 ± 3.86, while the MAE group presented similar values compared with the other group, ranging between 61.9 ± 3.92 and 72.1 ± 2.37. Conclusions: The value of implant insertion torque did not influence the ISQ values measured immediately after implant placement. However, the ITV influenced the ISQ values measured in the two initial periods of osseointegration, with implants installed with lower torques presenting higher ISQ values.

Can the Immediate Implantation With Immediate Loading Achieve an Acceptable Esthetic Outcome? A Prospective Observational Clinical Study

The trending protocol in implantology aims at integrating the esthetic on par with function while reducing discomfort and treatment time with optimal results. The purpose of this study was to evaluate the pink esthetic score in sites treated by graftless instant implantation that was boosted by instant provisionalization with a 2 to 3 mm jumping distance. Thirty-five implants were inserted in the extraction sockets of teeth of 29 healthy qualified patients (22 females and 7 males) with an age range of 23 to 60 years [mean±SD age 41.11±9.9 y). Preoperative assessment was complemented clinically and radiographically for each patient. The used system was Medentika dental implant (Germany). Osstell implant stability quotient was used to measure implant stability at the time of surgery (baseline) and at 16 weeks. Four implants in 3 patients failed. The implant survival rate was 88.6%. The protocol of this study produced a significant decrease in the jumping distance which is 2 to 3 mm at cone-beam computed tomography evaluation with satisfactory esthetic outcomes clinically. Further comparative studies with long-term and larger samples are needed to confirm the conclusion of this study.

Postsurgical Pain and Implant Osseointegration Failure: A Case Control Study

Aim. The relationship between postsurgical pain and osseointegration was evaluated and analyzed in this study. Material and method. 27 patients, ranging in age from 35 to 72 years old, 12 males and 15 females, who received dental implants and failed to achieve osseointegration from Tianjin Medical University Second Hospital, were analyzed and studied in the following aspects: bone density, initial torque, one- or two-stage surgery, postsurgical pain, postsurgical swelling, and radiographic evidence of osseointegration failure. Result. 5 patients were assessed to be D4 bone density and 7 cases were assessed to be D3 bone density, 2 patients were assessed to be D2 bone density and 13 patients were assessed to be D1 bone density. All cases were documented with clinically acceptable initial torque. Among the 27 cases, 2 of them were one-stage nonsubmerged surgery and 25 cases were two-stage submerged surgery. 25 out of 27 patients reported moderate to severe pain lasting for more than 72 hours. Radiologic examinations failed to offer any indication of poor osseointegration in the 7-day postsurgical follow-up. Conclusion. Moderate to severe postsurgical pain lasting more than 72 hours displays high odd ratio of poor osseointegrate. The radiological examinations alone failed to offer any valuable evidence for the early detection of osseointegration failure in this study.