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Imber JC, Khandanpour A, Roccuzzo A, Irani DR, Bosshardt DD, Sculean A, Pippenger BE. Comparative osseointegration of hydrophobic tissue-level tapered implants-A preclinical in vivo study. Clin Oral Implants Res 2024. [PMID: 39032079 DOI: 10.1111/clr.14318] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2023] [Revised: 05/16/2024] [Accepted: 06/04/2024] [Indexed: 07/22/2024]
Abstract
PURPOSE To histometrically compare the osseointegration and crestal bone healing of a novel tapered, self-cutting tissue-level test implant with a standard tissue-level control implant in a submerged healing regimen. MATERIALS AND METHODS In a mandibular minipig model, implants were inserted and evaluated histometrically after a healing period of 3, 6, and 12 weeks. The primary outcome was the evaluation of bone-to-implant contact (BIC) and secondary outcomes were primary stability as per insertion torque and first BIC (fBIC). Outcomes for the test and control implants were compared using Wilcoxon signed-rank tests and mixed linear regression models. RESULTS Insertion torque values were significantly higher for the test (50.0 ± 26.4 Ncm) compared to the control implants (35.2 ± 19.7 Ncm, p = .0071). BIC values of test implants were non-inferior to those of control implants over the investigated study period. After 12 weeks, the corresponding values measured were 81.62 ± 11.12% and 90.41 ± 4.81% (p = .1763) for test and control implants, respectively. Similarly, no statistical difference was found for fBIC values, except for the 12 weeks outcome that showed statistically lower values for the test (-675.58 ± 590.88 μm) compared to control implants (-182.75 ± 197.40 μm, p = .0068). CONCLUSIONS Novel self-cutting tissue-level implants demonstrated noninferior osseointegration and crestal bone height maintenance to the tissue-level implants. Histometric outcomes between both implants demonstrated test implants were statistically noninferior to control implants, despite substantial differences in the bone engagement mechanism and resulting differences in insertion torque and qualitative bone healing patterns.
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Affiliation(s)
- Jean-Claude Imber
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Azita Khandanpour
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Andrea Roccuzzo
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Delia R Irani
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Dieter D Bosshardt
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Anton Sculean
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
| | - Benjamin E Pippenger
- Department of Periodontology, School of Dental Medicine, University of Bern, Bern, Switzerland
- Department of Preclinical Research, Institut Straumann AG, Basel, Switzerland
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2
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Gehrke SA, Cortellari GC, de Oliveira Fernandes GV, Scarano A, Martins RG, Cançado RM, Mesquita AMM. Randomized Clinical Trial Comparing Insertion Torque and Implant Stability of Two Different Implant Macrogeometries in the Initial Periods of Osseointegration. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59010168. [PMID: 36676792 PMCID: PMC9862599 DOI: 10.3390/medicina59010168] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/06/2023] [Accepted: 01/10/2023] [Indexed: 01/19/2023]
Abstract
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.
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Affiliation(s)
- Sergio Alexandre Gehrke
- Department of Research, Bioface/PgO/UCAM, Calle Cuareim 1483, Montevideo 11100, Uruguay
- Instituto de Bioingenieria, Universidad Miguel Hernández, Avda. Ferrocarril s/n., 03202 Elche, Spain
- Department of Biotechnology, Universidad Católica de Murcia (UCAM), 30107 Murcia, Spain
- Department of Materials Engineering, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre 90619-900, Brazil
- Correspondence: ; Tel./Fax: +598-29015634
| | | | | | - Antonio Scarano
- Department of Research, Bioface/PgO/UCAM, Calle Cuareim 1483, Montevideo 11100, Uruguay
- Department of Innovative Technologies in Medicine & Dentistry, University of Chieti-Pescara, 66100 Chieti, Italy
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3
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Kotsakis GA, Romanos GE. Biological mechanisms underlying complications related to implant site preparation. Periodontol 2000 2022; 88:52-63. [PMID: 35103318 DOI: 10.1111/prd.12410] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Implant site preparation is a critical stage of implant surgery that may underpin various complications related to implant surgery. This review discusses the latest available scientific information on risk factors related to implant site preparation. The role of the drilling process in relation to the density of the available alveolar bone, the effects of insertion torque on peri-implant osseous healing, and implant-related variables such as macrodesign and implant-abutment connection are all factors that can influence implant success. Novel information that links osteotomy characteristics (including methods to improve implant initial stability, the impact of drilling speed, and increase of the implant insertion torque modifying the bone-implant interface) with the appropriate instrumentation techniques will be discussed, as well as interactions at the bone-biomaterial interface that may lead to biologic complications mediated by implant dissolution products.
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Affiliation(s)
| | - Georgios E Romanos
- Department of Periodontology, School of Dental Medicine, Stony Brook, New York, USA.,Department of Oral Surgery and Implant Dentistry, Dental School, Johann Wolfgang Goethe University, Frankfurt, Germany
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4
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Gehrke SA, Júnior JA, Treichel TLE, do Prado TD, Dedavid BA, de Aza PN. Effects of insertion torque values on the marginal bone loss of dental implants installed in sheep mandibles. Sci Rep 2022; 12:538. [PMID: 35017552 PMCID: PMC8752839 DOI: 10.1038/s41598-021-04313-5] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 12/14/2021] [Indexed: 12/15/2022] Open
Abstract
The aim of the present in vivo study was to analyze and compare the effects on the crestal bone healing of two different implant macrogeometries installed in fresh socket areas and in normal bone areas with different insertion torque values. Two implant macrogeometries were used in the present study, DuoCone implant (DC) and Maestro implant (MAE), forming four groups: group DCws, in which the implants were installed in healing bone (without a socket); group DCfs, in which the implants were installed in post-extraction areas (fresh sockets); group MAEws, in which the implants were installed in healing bone (without a socket); group MAEfs, in which the implants were installed in post-extraction areas (fresh sockets). After 30 and 90 days of implantations in the bilateral mandibles of 10 sheep, eighty implants were evaluated through digital X-ray images and histologic slices. The crestal bone position in relation to the implant platform shoulder was measured and compared. The measured insertion torque was 47.2 ± 4.69 Ncm for the DCws group, 43.4 ± 4.87 Ncm for the DCfs group, 29.3 ± 3.16 Ncm for the MAEws group, and 27.7 ± 4.41 Ncm for the MAEfs group. The radiographic mesio-distal and histological bucco-lingual analyses showed significantly greater vertical bone loss in the implants installed with high torque (DC groups) in comparison to the implants installed with a low torque (MAE groups) (p < 0.05), at both evaluation times. In general, low insertion torque values (Maestro implants) showed better results of MBL when compared to implants installed with higher torque values (Duo Cone implants). Moreover, our results showed that the implants installed in the sites without sockets showed a less MBL in comparison with the implants installed in sites of fresh sockets.
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Affiliation(s)
- Sergio Alexandre Gehrke
- Department of Biotechnology, Universidad Católica de Murcia, 30107, Murcia, Spain.
- Department of Research, Biotecnos - Technology and Science, Cuareim 1483, 11100, Montevideo, Uruguay.
| | | | | | - Tales Dias do Prado
- Department of Surgery, Faculty of Medicine Veterinary, University of Rio Verde, Rio Verde, Brazil
| | - Berenice Anina Dedavid
- Department of Materials Engineering, Pontificia Universidade Católica do Rio Grande do Sul, Porto Alegre, 90619-900, Brazil
| | - Piedad N de Aza
- Department of Materials, Instituto de Bioingenieria, Universidad Miguel Hernández, Elche, Alicante, Spain
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5
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Gehrke SA, Júnior JA, Eirles Treichel TL, Dedavid BA. Biomechanical and histological evaluation of four different implant macrogeometries in the early osseointegration process: An in vivo animal study. J Mech Behav Biomed Mater 2021; 125:104935. [PMID: 34736028 DOI: 10.1016/j.jmbbm.2021.104935] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Revised: 08/16/2021] [Accepted: 10/25/2021] [Indexed: 12/16/2022]
Abstract
This study aims to evaluate the effects of implant macrogeometry on the early period of the osseointegration process, comparing four different implant models through biomechanical and histological analysis after implantation in rabbit tibiae. Twenty New Zealand rabbits were used, evaluated at two different times (21 and 28 days) after installation of the implant. Eighty implants with different macrogeometries were used, forming four groups (n = 20 per group): cylindrical implants Ø4.1 mm and 8 mm in length (STRc group); cylindrical-conical implants Ø4.1 mm and 8 mm in length (STRt group); tapered implants Ø4.3 mm and 8 mm in length (NOBt group); and tapered implants with healing chambers Ø4.0 mm and 8 mm in length (MAEt group). Ten samples from each group were analyzed at each proposed time. The initial implant stability quotient (ISQ) was measured by resonance frequency analysis, both at the time of installation and at the time of sacrifice. In the histological sections, the percentage of bone-implant contact (BIC%), newly formed bone, osteoid matrix, and medullary spaces were measured in the pre-determined cortical and medullary bone portion for each sample. The three tapered implant groups (STRt, NOBt, and MAEt) showed higher values for the analyzed parameters in the early osseointegration period, in comparison with the cylindrical implant group (STRc). In all parameters, the three tapered groups showed no difference (p > 0.05); however, all three tapered groups presented significant differences, when compared to the cylindrical group (p < 0.05). No correlation was detected between the parameters analyzed. Within the limitations of the present study, in all parameters analyzed, the tapered implants demonstrated greater results when compared to the cylindrical implants.
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Affiliation(s)
- Sergio Alexandre Gehrke
- Department of Biotechnology, Universidad Católica de Murcia, 30107, Murcia, Spain; Department of Research, Biotecnos - Technology and Science, 11100, Montevideo, Uruguay.
| | | | | | - Berenice Anina Dedavid
- Department of Materials Engineering, Pontificia Universidade Católica do Rio Grande do Sul, 90619-900, Porto Alegre, Brazil.
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6
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Gehrke SA, Scarano A, de Lima JHC, Bianchini MA, Dedavid BA, De Aza PN. Effects of the Healing Chambers in Implant Macrogeometry Design in a Low-Density Bone Using Conventional and Undersized Drilling. J Int Soc Prev Community Dent 2021; 11:437-447. [PMID: 34430506 PMCID: PMC8352059 DOI: 10.4103/jispcd.jispcd_96_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 06/14/2021] [Accepted: 05/22/2021] [Indexed: 11/04/2022] Open
Abstract
Background: The ideal installation technique or implant macrogeometry for obtaining an adequate osseointegration in low-density bone tissue follows a challenge in the implantology. Aims and Objective: The aim of the present study was to evaluate the behavior of three osteotomy techniques and two implant macrogeometries in two low-density polyurethane blocks. The insertion torque (IT), initial stability, pullout resistance, and weight of the residual bone material deposited on the implants were assessed. Materials and Methods: A total of 120 implants with two different macrogeometries were used. They were divided into six groups according to the implant macrogeometry and the drilling technique performed (n = 20 implants per group). The implants were installed in polyurethane blocks with pounds per cubic foot (PCF) 10 and PCF 20 densities. The IT, initial stability, pullout resistance, and weight residual bone were measured. Results: Differences were found in the values referring to the macrogeometry of the implants and the type of osteotomy performed. In all groups, the initial stability of the PCF 10 blocks was quite low. The undersized osteotomies significantly increased the values measured in all tests in the PCF 20 density blocks. Conclusions: In conclusion, even when a modified (undersized) osteotomy technique is used, implants inserted in low-quality bone (type IV) can present problems for osseointegration due their low initial stability and bone resistance. However, the modification in the implant macrogeometry (with healing chambers) presented more quantity of bone on the surface after the pullout test.
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Affiliation(s)
- Sergio A Gehrke
- Department of Research, Biotecnos, Montevideo, Uruguay.,Department of Biotechnology, Universidad Católica de Murcia, Murcia, Spain.,Instituto de Bioingenieria, Universidad Miguel Hernández, Elche (Alicante), Spain
| | - Antônio Scarano
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | - José H C de Lima
- Department of Rehabilitation, Universidade Federal Fluminense, Rio de Janeiro, Brazil
| | - Marco A Bianchini
- Post-Graduate Program in Implant Dentistry, Federal University of Santa Catarina, Florianópolis, SC, Brazil
| | - Berenice A Dedavid
- Department of Materials Engineering, Pontificia Catholic University of Rio Grande do Sul, Porto Alegre, Brazil
| | - Piedad N De Aza
- Instituto de Bioingenieria, Universidad Miguel Hernández, Elche (Alicante), Spain
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7
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El Chaar E, Puisys A, Sabbag I, Bellón B, Georgantza A, Kye W, Pippenger BE. A novel fully tapered, self-cutting tissue-level implant: non-inferiority study in minipigs. Clin Oral Investig 2021; 25:6127-6137. [PMID: 33861379 PMCID: PMC8531107 DOI: 10.1007/s00784-021-03912-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Accepted: 03/23/2021] [Indexed: 11/29/2022]
Abstract
Objectives To assess the osseointegration and crestal bone level maintenance of a novel fully tapered self-cutting tissue-level implant for immediate placement (test) compared to a clinically established tissue-level implant (control) in moderate bone quality. Materials and methods Test and control implants were compared in 3 groups, i.e., small-, medium-, and large-diameter implants in an edentulous mandibular minipig model with moderate bone quality after 12 weeks of healing. Histometrically derived bone-to-implant contact (BIC) and first bone-to-implant contact (fBIC) were subjected to statistical non-inferiority testing. Maximum insertion torque values in artificial bone were assessed for comparison. Results BIC values for the tests and control implants for all 3 diameters were comparable and non-inferior: small diameter (61.30 ± 10.63% vs. 54.46 ± 18.31%) (p=0.99), medium diameter (60.91 ± 14.42 vs. 54.68 ± 9.16) (p=0.55), and large diameter (45.60 ± 14.67 vs. 52.52 ± 14.76) (p=0.31). fBIC values for test implants were higher and non-inferior compared to control implants in all three groups. Test implants further showed distinctly higher maximum insertion torque values compared to control implants. Conclusion The investigated novel tissue-level implant is able to achieve high levels of primary and secondary implant stability under simultaneous preservation of crestal bone levels. This qualifies the studied implant as an attractive candidate for immediate placement in bone of limited quality. Clinical relevance This pilot pre-clinical study investigated a novel tissue-level implant for immediate placement. With the aim of translating the studied prototype into clinical application pre-clinical models, procedures and controls have been chosen with the aim of reflecting its future clinical indication and use. Supplementary Information The online version contains supplementary material available at 10.1007/s00784-021-03912-w.
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Affiliation(s)
- Edgard El Chaar
- Department of Periodontology and Implant Dentistry, New York University, New York, USA
| | - Algirdas Puisys
- Vilnius Research Group, Vilnius, Lithuania.,Vilnius Implantology Center, Vilnius, Lithuania
| | - Itai Sabbag
- Lahav Research Institute, Kibbutz Lahav, Israel
| | - Benjamin Bellón
- Department of Preclinical and Translational Research, Institut Straumann AG, Basel, Switzerland.,Department of Periodontology, Faculty of Dentistry, University of Zurich, Zurich, Switzerland
| | - Aikaterini Georgantza
- Department of Periodontology and Implant Dentistry, New York University, New York, USA
| | - Wayne Kye
- Department of Periodontology and Implant Dentistry, New York University, New York, USA
| | - Benjamin E Pippenger
- Department of Preclinical and Translational Research, Institut Straumann AG, Basel, Switzerland. .,Department of Periodontology, Faculty of Dentistry, University of Bern, Freiburgstrasse 7, CH-3010, Bern, Switzerland.
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8
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Sierra-Rebolledo A, Tariba-Forero D, Rios-Calvo MD, Gay-Escoda C. Effect of undersized drilling on the stability of immediate tapered implants in the anterior maxillary sector. A randomized clinical trial. Med Oral Patol Oral Cir Bucal 2021; 26:e187-e194. [PMID: 33395401 PMCID: PMC7980290 DOI: 10.4317/medoral.24107] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 12/11/2020] [Indexed: 11/29/2022] Open
Abstract
Background To evaluate the effect of undersized drilling on the primary and secondary stability of immediate implants placed in the anterior maxilla.
Material and Methods A comparative randomized clinical trial was carried out in 30 healthy adults. Thirty tapered implants, 16 involving conventional drilling and 14 undersized drilling, were placed immediately after anterior maxillary tooth removal. Insertion torque and implant stability assessed by resonance frequency analysis (RFA) were evaluated at three different timepoints: at implant placement and 6 and 12 weeks post-implantation. The results were compared using parametric statistical tests.
Results All implants showed adequate stability during follow-up. At implant placement, the undersized drilling group exhibited greater insertion torque values than the conventional drilling group, but stability assessed by RFA showed greater mean values in the conventional group. After 6 and 12 weeks of follow-up, both groups showed improved stability, though the RFA values remained comparatively higher in the conventional group. The differences were not statistically significant.
Conclusions Based on the results obtained, undersized drilling does not appear to afford significantly improved stability of immediate implants placed in the anterior zone of the maxilla during the osseointegration period. Key words:Insertion torque, RFA, undersized drilling, immediate implants, primary stability, secondary stability.
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Affiliation(s)
- A Sierra-Rebolledo
- Departamento de Estomatoquirúrgica Unidad de Investigaciones Morfo-Patológicas (UNIMPA), Pabellon 11 Campus Barbula, Facultad de Odontología, Universidad de Carabobo Valencia, Venezuela
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9
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Evaluation of Insertion Energy as Novel Parameter for Dental Implant Stability. J Clin Med 2020; 9:jcm9092977. [PMID: 32942697 PMCID: PMC7565125 DOI: 10.3390/jcm9092977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2020] [Revised: 09/04/2020] [Accepted: 09/10/2020] [Indexed: 11/17/2022] Open
Abstract
Insertion energy has been advocated as a novel measure for primary implant stability, but the effect of implant length, diameter, or surgical protocol remains unclear. Twenty implants from one specific bone level implant system were placed in layered polyurethane foam measuring maximum insertion torque, torque–time curves, and primary stability using resonance frequency analysis (RFA). Insertion energy was calculated as area under torque–time curve applying the trapezoidal formula. Statistical analysis was based on analysis of variance, Tukey honest differences tests and Pearson’s product moment correlation tests (α = 0.05). Implant stability (p = 0.01) and insertion energy (p < 0.01) differed significantly among groups, while maximum insertion torque did not (p = 0.17). Short implants showed a significant decrease in implant stability (p = 0.01), while reducing implant diameter did not cause any significant effect. Applying the drilling protocol for dense bone resulted in significantly increased insertion energy (p = 0.02) but a significant decrease in implant stability (p = 0.04). Insertion energy was not found to be a more reliable parameter for evaluating primary implant stability when compared to maximum insertion torque and resonance frequency analysis.
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10
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Staedt H, Kämmerer PW, Goetze E, Thiem DGE, Al-Nawas B, Heimes D. Implant primary stability depending on protocol and insertion mode - an ex vivo study. Int J Implant Dent 2020; 6:49. [PMID: 32880030 PMCID: PMC7468011 DOI: 10.1186/s40729-020-00245-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 07/15/2020] [Indexed: 12/11/2022] Open
Abstract
Background Dental implant primary stability is thought to be a fundamental prerequisite for the long-term survival and success. The aim of this study was to analyze the influence of protocol and insertion mode on dental implant stability ex vivo. One hundred and twenty implants were inserted either manually or machine-driven into porcine mandibles by a standard or over-dimensioned protocol. Dental implant stability was measured via resonance frequency analysis (RFA), insertion torque (IT), and torque out (TO). Results Statistically significant higher IT and TO values were seen after standard protocol insertion (p < 0.05), whereas manual and machine-driven insertion mode showed equivalent values. Conclusions The over-dimensioned protocol exceeded the primary stability values recommended for immediate implant insertion; therefore, it could be recommended as well.
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Affiliation(s)
- Henning Staedt
- Private Practice and Department of Prosthodontics and Materials Science, University Medical Center Rostock, Strempelstraße 13, 18057, Rostock, Germany
| | - Peer W Kämmerer
- Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Elisabeth Goetze
- Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Daniel G E Thiem
- Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Bilal Al-Nawas
- Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Diana Heimes
- Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
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11
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Kotsu M, Urbizo Velez J, Bengazi F, Tumedei M, Fujiwara S, Kato S, Botticelli D. Healing at implants installed from ~ 70- to < 10-Ncm insertion torques: an experimental study in dogs. Oral Maxillofac Surg 2020; 25:55-64. [PMID: 32725574 DOI: 10.1007/s10006-020-00890-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2020] [Accepted: 07/22/2020] [Indexed: 12/12/2022]
Abstract
OBJECTIVE To evaluate histologically the early healing at implants installed with different insertion torques MATERIAL AND METHODS: Three months after the extraction of the mandibular premolars and of the first molars, two implants were installed monolaterally in the premolar and two in the molar regions of the edentulous alveolar ridge of twelve dogs. The recipient sites were prepared using drills of different diameter to obtain insertion torque of different values, i.e., 30 Ncm (control) or ~ 70 Ncm (test) in the premolar region, and < 10 Ncm (test) or ~ 50 Ncm (control) in the molar region. Six animals were euthanized after 4 weeks and six after 8 weeks of healing. Histological analyses were performed, and the Wilcoxon test was applied for statistical analyses. RESULTS After 4 weeks of healing, in the premolar region, the new bone in contact with the implant surface was 65.0 ± 4.6% and 53.9 ± 13.5% at the ~ 30-Ncm and ~ 70-Ncm sites, respectively (p = 0.075). In the premolar region, new bone proportions were 51.4 ± 17.0% and 67.3 ± 7.0% at the < 10-Ncm and ~ 50-Ncm sites, respectively (p = 0.046). After 8 weeks of healing, in the premolar region, new bone reached fractions of 77.7 ± 16.2% at the ~ 30-Ncm sites, and 68.3 ± 12.1% at the ~ 70-Ncm sites (p = 0.028). In the molar region, new bone presented proportions of 70.2 ± 6.4% at the < 10-Ncm sites and 76.2 ± 9.4% at the ~ 50-Ncm sites (p = 0.173). CONCLUSIONS The insertion torque influenced the osseointegration of implants. Higher values of bone-to-implant contact percentages were registered for insertion torques of ~ 30 Ncm and ~ 50 Ncm. Implants inserted with torque < 10 Ncm became integrated with an optimal osseointegration.
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Affiliation(s)
- Mitsuo Kotsu
- ARDEC Academy, Viale Giovanni Pascoli 67, Rimini, Italy
| | | | - Franco Bengazi
- Faculty of Dentistry, University of Medical Science, Havana, Cuba
| | - Margherita Tumedei
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Chieti, Italy
| | | | - Shingo Kato
- ARDEC Academy, Viale Giovanni Pascoli 67, Rimini, Italy
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12
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Grobecker-Karl T, Karl M, Steiner C. Insertion torque/time integral as a measure of primary implant stability. BIOMED ENG-BIOMED TE 2020; 65:/j/bmte.ahead-of-print/bmt-2020-0039/bmt-2020-0039.xml. [PMID: 32589592 DOI: 10.1515/bmt-2020-0039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2019] [Accepted: 03/27/2020] [Indexed: 11/15/2022]
Abstract
The goal of this in vitro study was to determine the insertion torque/time integral for three implant systems. Bone level implants (n = 10; BLT - Straumann Bone Level Tapered 4.1 mm × 12 mm, V3 - MIS V3 3.9 mm × 11.5 mm, ASTRA - Dentsply-Sirona ASTRA TX 4.0 mm × 13 mm) were placed in polyurethane foam material consisting of a trabecular and a cortical layer applying protocols for medium quality bone. Besides measuring maximum insertion torque and primary implant stability using resonance frequency analysis (RFA), torque time curves recorded during insertion were used for calculating insertion torque/time integrals. Statistical analysis was based on ANOVA, Tukey's honest differences test and Pearson product moment correlation (α = 0.05). Significantly greater mean maximum insertion torque (59.9 ± 4.94 Ncm) and mean maximum insertion torque/time integral (961.64 ± 54.07 Ncm∗s) were recorded for BLT implants (p < 0.01). V3 showed significantly higher mean maximum insertion torque as compared to ASTRA (p < 0.01), but significantly lower insertion torque/time integral (p < 0.01). Primary implant stability did not differ significantly among groups. Only a single weak (r = 0.61) but significant correlation could be established between maximum insertion torque and insertion torque/time integral (p < 0.01) when all data from all three implant groups were pooled. Implant design (length, thread pitch) seems to affect insertion torque/time integral more than maximum insertion torque.
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Affiliation(s)
- Tanja Grobecker-Karl
- Department of Prosthodontics, Saarland University, Kirrberger Strasse 100, Homburg/Saar, Germany
| | - Matthias Karl
- Department of Prosthodontics, Saarland University, Kirrberger Strasse 100, 66421 Homburg/Saar, Germany
| | - Constanze Steiner
- Department of Prosthodontics, Saarland University, Kirrberger Strasse 100, Homburg/Saar, Germany
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Under-Drilling versus Hybrid Osseodensification Technique: Differences in Implant Primary Stability and Bone Density of the Implant Bed Walls. MATERIALS 2020; 13:ma13020390. [PMID: 31952138 PMCID: PMC7013970 DOI: 10.3390/ma13020390] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Revised: 01/08/2020] [Accepted: 01/13/2020] [Indexed: 01/11/2023]
Abstract
The goal of this study was to evaluate the effects of two implant bed preparation techniques on the implant primary stability (IPS) and the bone density of the implant site. We completed 40 implant bed osteotomies in pig ribs using two techniques: osseodensification (OD) plus under-drilling (UD) with universal osseodensification drills (Test A), and under-drilling alone with drills of the same implant system (Test B). Implants with a 4.1 mm diameter and 10 mm length were inserted, and the IPS was evaluated with three methods: (insertion torque (IT), periotest (PTV), and resonance frequency analysis (RFA). The bone density was evaluated using micro-computed tomography. ANOVA and Tukey’s post-hoc test were used for comparison of the IPS values, and Kruskal–Wallis was used to evaluate the bone density. Statistical significance was set at p < 0.05. The tested B technique (UD) achieved a higher IPS compared to the Test A technique (OD + UD) for all the evaluation methods (p < 0.05). Bone density was higher at the apical and middle region in Test A compared to Test B and control sites (p < 0.05). We concluded that although the bone density increased with the hybrid OD technique with universal drills, implant beds prepared with UD using drills with geometry similar to that of the implant are more efficient at increasing IPS values.
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Grobecker‐Karl T, Palarie V, Schneider S, Karl M. Does intraoperative bone density testing correlate with parameters of primary implant stability? A pilot study in minipigs. Clin Exp Dent Res 2019; 5:594-600. [PMID: 31890296 PMCID: PMC6934340 DOI: 10.1002/cre2.224] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 11/15/2022] Open
Abstract
Objectives Bone density, surgical protocol, and implant design are the major determinants of primary stability. The goal of this animal trial was to investigate potential correlations of intraoperative bone density testing with clinical and histologic parameters of primary implant stability. Material and methods Following extractions of all mandibular premolars and subsequent healing, four implants each were placed in a total of four minipigs. Bone density was determined by applying intraoperative compressive tests using a device named BoneProbe whereas measurements of implant insertion torque and resonance frequency analysis were used for evaluating implant stability. Bone mineral density (BMD) and bone to implant contact were quantified after harvesting mandibular block sections. Spearman rank correlation tests were performed for evaluating correlations (α = .05). Results Due to variation in clinical measurements, only weak correlations could be identified. A positive correlation was found between the parameters bone to implant contact and BMD (Spearman's rho .53; p = .05) whereas an inverse correlation was observed between BMD and implant stability (Spearman's rho -.61; p = .03). Both BoneProbe measurements in the cortical and trabecular area positively correlated with implant insertion torque (Spearman's rho 0.60; p = .02). A slightly stronger correlation was observed between the average of both BoneProbe measurements and implant insertion torque (Spearman's rho.66; p = .01). Conclusions While establishing exact relationships among parameters of implant stability and the measurement techniques applied would require greater sample size, intraoperative compressive testing of bone might, despite the weak correlations seen here, be a useful tool for predicting primary implant stability.
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Affiliation(s)
| | - Victor Palarie
- Department of Oral and Maxillofacial Surgery and Oral Implantology "A. Gutan"University of Medicine and Pharmacy "N. Testemitanu"ChisinauMoldova
| | - Sonja Schneider
- Department of ProsthodonticsSaarland UniversityHomburgGermany
| | - Matthias Karl
- Department of ProsthodonticsSaarland UniversityHomburgGermany
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New Implant Macrogeometry to Improve and Accelerate the Osseointegration: An In Vivo Experimental Study. APPLIED SCIENCES-BASEL 2019. [DOI: 10.3390/app9153181] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
A new implant design with healing chambers in the threads was analyzed and compared with a conventional implant macrogeometry, both implants models with and without surface treatment. Eighty conical implants were prepared using commercially pure titanium (grade IV) by the company Implacil De Bortoli (São Paulo, Brazil). Four groups were performed, as described below: Group 1 (G1), traditional conical implants with surface treatment; group 2 (G2), traditional conical implants without surface treatment (machined surface); group 3 (G3), new conical implant design with surface treatment; group 4 (G4), new conical implant design without surface treatment. The implants were placed in the two tibias (n = 2 implants per tibia) of twenty New Zealand rabbits determined by randomization. The animals were euthanized after 15 days (Time 1) and 30 days (Time 2). The parameters evaluated were the implant stability quotient (ISQ), removal torque values (RTv), and histomorphometric evaluation to determine the bone to implant contact (%BIC) and bone area fraction occupancy (BAFO%). The results showed that the implants with the macrogeometry modified with healing chambers in the threads produced a significant enhancement in the osseointegration, accelerating this process. The statistical analyses of ISQ and RTv showed a significative statistical difference between the groups in both time periods of evaluation (p ≤ 0.0001). Moreover, an important increase in the histological parameters were found for groups G3 and G4, with significant statistical differences to the BIC% (in the Time 1 p = 0.0406 and in the Time 2 p < 0.0001) and the BAFO% ((in the Time 1 p = 0.0002 and in the Time 2 p = 0.0045). In conclusion, the result data showed that the implants with the new macrogeometry, presenting the healing chambers in the threads, produced a significant enhancement in the osseointegration, accelerating the process.
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