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Ferreira Balan V, Ferri M, Pires Godoy E, Artioli LG, Botticelli D, Silva ER, Xavier SP. Controlled Lateral Pressure on Cortical Bone Using Blade-Equipped Implants: An Experimental Study in Rabbits. Bioengineering (Basel) 2024; 11:835. [PMID: 39199793 PMCID: PMC11352121 DOI: 10.3390/bioengineering11080835] [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: 07/07/2024] [Revised: 08/05/2024] [Accepted: 08/12/2024] [Indexed: 09/01/2024] Open
Abstract
BACKGROUND This study aimed to evaluate the biological behavior of a novel implant design incorporating decompressive cervical blades. Hence, the aim of the present study was to evaluate the healing outcomes in cortical regions where decompressive protocols were implemented using implants equipped with blades and installed applying a bicortical anchorage. MATERIALS AND METHODS Blades with varying diameters were integrated into the coronal portion of the implant to prepare the cortical region of rabbit tibiae. The blade diameters differed from the implant collar by the following amounts: control group (0 µm), +50 µm, and +200 µm. RESULTS No marginal bone loss was detected. Instead, all implants exhibited new bone formation in the coronal region. Complete closure was observed in the CG-0 group, as well as in the TG-50 and TG-200 groups, despite the presence of marginal gaps without primary bone contact at installation. In the apical region, most implants breached the cortical layer. Nevertheless, new bone formation in this region completely closed the osteotomy, effectively isolating the internal environment of the tibia from the external. CONCLUSIONS The use of a blade incorporated into the implant body enabled precise preparation of the cortical layer, allowing for controlled decompression in the targeted area. This technique resulted in optimal osseointegration with no loss of marginal bone, and complete restoration of marginal gaps ranging from 0 µm to 200 µm.
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Affiliation(s)
- Vitor Ferreira Balan
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto 14040-904, SP, Brazil; (V.F.B.); (L.G.A.); (E.R.S.); (S.P.X.)
| | - Mauro Ferri
- Private Practice, Cartagena de Indias 130001, Colombia;
| | - Eduardo Pires Godoy
- Department of Basic and Oral Biology, Ribeirão Preto School of Dentistry, University of São Paulo, Ribeirão Preto 14040-904, SP, Brazil;
| | - Leticia Gabriela Artioli
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto 14040-904, SP, Brazil; (V.F.B.); (L.G.A.); (E.R.S.); (S.P.X.)
| | | | - Erick Ricardo Silva
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto 14040-904, SP, Brazil; (V.F.B.); (L.G.A.); (E.R.S.); (S.P.X.)
| | - Samuel Porfirio Xavier
- Department of Oral and Maxillofacial Surgery and Periodontology, Faculty of Dentistry of Ribeirão Preto, University of São Paulo, Av. do Café-Subsetor Oeste-11 (N-11), Ribeirão Preto 14040-904, SP, Brazil; (V.F.B.); (L.G.A.); (E.R.S.); (S.P.X.)
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Olmedo-Gaya MV, Romero-Olid MN, Ocaña-Peinado FM, Vallecillo-Rivas M, Vallecillo C, Reyes-Botella C. Influence of different surgical techniques on primary implant stability in the posterior maxilla: a randomized controlled clinical trial. Clin Oral Investig 2023:10.1007/s00784-023-04962-y. [PMID: 36977760 DOI: 10.1007/s00784-023-04962-y] [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: 12/15/2022] [Accepted: 03/19/2023] [Indexed: 03/30/2023]
Abstract
BACKGROUND AND OBJECTIVE Primary stability (PS) is remarkable for secondary stability and implant success. Surgical technique modifications seem to improve primary stability, especially in poor quality bone. The aim of this study was to compare the insertion torque (IT) and implant stability quotients (ISQ) of implants placed with underpreparation, expanders, and standard surgical instrumentation in different bone types. MATERIAL AND METHODS This randomized controlled clinical trial enrolled 108 patients (n=108 implants) distributed in three study groups: group 1 (n=36) underpreparation technique, group 2 (n=36) expander technique, and group 3 (n=36) conventional drilling. IT was recorded with a torque indicator. ISQ was recorded with resonance frequency analysis immediately after surgery. RESULTS ISQ values were associated with the patient's bone quality and were higher in bone quality type II (76.65) and type III (73.60) and lower in bone quality type IV (67.34), with statistically significant differences (p<0.0001). Lower stability results were obtained when conventional drilling (69.31) was used compared to the use of underpreparation (74.29) or expanders (73.99) with a level of significance of p=0.008 and p=0.005, respectively. CONCLUSIONS The surgical technique influences the PS when there is low-quality bone. In low-quality bones, conventional drilling obtains lower ISQ values. CLINICAL RELEVANCE Replace the conventional drilling technique for an alternative, underpreparation or expanders, in low-quality bone in order to achieve greater primary stability.
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Affiliation(s)
| | | | | | | | - Cristina Vallecillo
- Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain.
- Faculty of Dentistry, University of Granada, Colegio Máximo de Cartuja s/n, 18071, Granada, Spain.
| | - Candela Reyes-Botella
- Department of Stomatology, School of Dentistry, University of Granada, Granada, Spain
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Di Stefano DA, Arosio P, Capparè P, Barbon S, Gherlone EF. Stability of Dental Implants and Thickness of Cortical Bone: Clinical Research and Future Perspectives. A Systematic Review. MATERIALS 2021; 14:ma14237183. [PMID: 34885335 PMCID: PMC8658728 DOI: 10.3390/ma14237183] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 11/12/2021] [Accepted: 11/22/2021] [Indexed: 12/30/2022]
Abstract
Dental surgery implantation has become increasingly important among procedures that aim to rehabilitate edentulous patients to restore esthetics and the mastication ability. The optimal stability of dental implants is correlated primarily to the quality and quantity of bone. This systematic literature review describes clinical research focusing on the correlation between cortical bone thickness and primary/secondary stability of dental fixtures. To predict successful outcome of prosthetic treatment, quantification of bone density at the osteotomy site is, in general, taken into account, with little attention being paid to assessment of the thickness of cortical bone. Nevertheless, local variations in bone structure (including cortical thickness) could explain differences in clinical practice with regard to implantation success, marginal bone resorption or anchorage loss. Current knowledge is preliminarily detailed, while tentatively identifying which inconclusive or unexplored aspects merit further investigation.
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Affiliation(s)
- Danilo Alessio Di Stefano
- Dental School, Vita-Salute University IRCCS San Raffaele, 20132 Milan, Italy; (D.A.D.S.); (E.F.G.)
- Private Practitioner, 20132 Milan, Italy
| | | | - Paolo Capparè
- Department of Dentistry, Vita-Salute University IRCCS San Raffaele, 20132 Milan, Italy
- Correspondence: ; Tel.: +39-0226433619
| | - Silvia Barbon
- Section of Human Anatomy, Department of Neurosciences, Padua University, 35121 Padua, Italy;
| | - Enrico Felice Gherlone
- Dental School, Vita-Salute University IRCCS San Raffaele, 20132 Milan, Italy; (D.A.D.S.); (E.F.G.)
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Blanc-Sylvestre N, Bouchard P, Chaussain C, Bardet C. Pre-Clinical Models in Implant Dentistry: Past, Present, Future. Biomedicines 2021; 9:1538. [PMID: 34829765 PMCID: PMC8615291 DOI: 10.3390/biomedicines9111538] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2021] [Revised: 10/11/2021] [Accepted: 10/15/2021] [Indexed: 12/23/2022] Open
Abstract
Biomedical research seeks to generate experimental results for translation to clinical settings. In order to improve the transition from bench to bedside, researchers must draw justifiable conclusions based on data from an appropriate model. Animal testing, as a prerequisite to human clinical exposure, is performed in a range of species, from laboratory mice to larger animals (such as dogs or non-human primates). Minipigs appear to be the animal of choice for studying bone surgery around intraoral dental implants. Dog models, well-known in the field of dental implant research, tend now to be used for studies conducted under compromised oral conditions (biofilm). Regarding small animal models, research studies mostly use rodents, with interest in rabbit models declining. Mouse models remain a reference for genetic studies. On the other hand, over the last decade, scientific advances and government guidelines have led to the replacement, reduction, and refinement of the use of all animal models in dental implant research. In new development strategies, some in vivo experiments are being progressively replaced by in vitro or biomaterial approaches. In this review, we summarize the key information on the animal models currently available for dental implant research and highlight (i) the pros and cons of each type, (ii) new levels of decisional procedures regarding study objectives, and (iii) the outlook for animal research, discussing possible non-animal options.
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Affiliation(s)
- Nicolas Blanc-Sylvestre
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
- AP-HP, Department of Periodontology, Rothschild Hospital, European Postgraduate in Periodontology and Implantology, Université de Paris, 75012 Paris, France
| | - Philippe Bouchard
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
- AP-HP, Department of Periodontology, Rothschild Hospital, European Postgraduate in Periodontology and Implantology, Université de Paris, 75012 Paris, France
| | - Catherine Chaussain
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
- AP-HP, Reference Center for Rare Disorders of the Calcium and Phosphate Metabolism, Dental Medicine Department, Bretonneau Hospital, GHN-Université de Paris, 75018 Paris, France
| | - Claire Bardet
- Université de Paris, Institut des Maladies Musculo-Squelettiques, Orofacial Pathologies, Imaging and Biotherapies Laboratory URP2496 and FHU-DDS-Net, Dental School, and Plateforme d’Imagerie du Vivant (PIV), 92120 Montrouge, France; (N.B.-S.); (P.B.); (C.C.)
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Does the Modification of the Apical Geometry of a Dental Implant Affect Its Primary Stability? A Comparative Ex Vivo Study. MATERIALS 2021; 14:ma14071728. [PMID: 33915933 PMCID: PMC8036940 DOI: 10.3390/ma14071728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 01/14/2023]
Abstract
(1) Background: Primary stability—one fundamental criterion for the success of dental implants—is influenced by implant geometry even if the effect of apical shape modifications on implant primary stability has not yet been examined. Therefore, the aim of the ex vivo study was to compare primary stability of implants differing in apically located screw threads (J-line) or a flat tip (K-line) only. (2) Methods: 28 implants of each group of the same diameter (4.3 mm) were randomly inserted into porcine bone blocks. The first group (9, 11 and 13 mm) was inserted into “hard”, the second (11 mm) into “soft” bone, here using a normal and an undersized drilling protocol. Insertion torque (Ncm), Periotest® value, resonance frequency (implant stability coefficient, ISQ) and push-out force (N) were measured. (3) Results: In “hard” bone, primary stability increased with increasing length in both groups but it was significantly higher in J-line (p < 0.03). An undersized preparation of the implant bed in “soft” bone resulted in a significant increase in primary stability in both groups. Here, J-line also showed a significantly increased primary stability when compared to equally prepared K-line (insertion torque: 37 Ncm vs. 26 Ncm; Periotest®: −6.5 vs. −4.3; push-out force: 365 N vs. 329 N; p < 0.05 each). (4) Conclusions: Primary stability is significantly higher with increasing implant length and apically located screw threads as well as with undersized drilling protocols. When preparing the implant site and subsequently selecting the implant system, modifying factors such as implant geometry (also at the tip) should be taken into account.
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Tumedei M, Piattelli A, Falco A, De Angelis F, Lorusso F, Di Carmine M, Iezzi G. An in vitro evaluation on polyurethane foam sheets of the insertion torque, removal torque values, and resonance frequency analysis (RFA) of a self-tapping threads and round apex implant. CELLULAR POLYMERS 2020. [DOI: 10.1177/0262489320971796] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
The dental implant primary stability and micromovement absence represent critical factor for dental implant osseointegration. The aim of the present in vitro investigation was to simulate the bone response on different polyurethane densities the effect of self-tapping threads and round apex implant geometry. A total of 40 implants were positioned in D1, D2, D3 and D4 polyurethane block densities following a calibrated drilling protocol. The Insertion, removal Torque and resonance frequency analysis (RFA) means were calculated. All experimental conditions showed insertion torque values >30 Ncm. A significant higher insertion torque, removal and RFA was present in D1 polyurethane. Similar evidences were evidenced for D3 and D4. The effectiveness of the present study suggested a valuable clinical advantage for self-tapping threads and round apex implant using, such as in case of reduced bone density in the posterior maxilla
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Affiliation(s)
- Margherita Tumedei
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, Chieti, Italy
| | - Adriano Piattelli
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, Chieti, Italy
- Chair of Biomaterials Engineering, Catholic University of San Antonio de Murcia (UCAM), Av. de los Jerónimos, Guadalupe, Murcia, Spain
- Fondazione Villa Serena per la Ricerca, Città Sant’Angelo (PE), Italy
| | | | - Francesco De Angelis
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, Chieti, Italy
| | - Felice Lorusso
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, Chieti, Italy
| | | | - Giovanna Iezzi
- Department of Medical, Oral and Biotechnological Sciences, University of Chieti-Pescara, Via dei Vestini, Chieti, Italy
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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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Histological and Histomorphometrical Evaluation of a New Implant Macrogeometry. A Sheep Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103477. [PMID: 32429405 PMCID: PMC7277453 DOI: 10.3390/ijerph17103477] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 05/12/2020] [Accepted: 05/13/2020] [Indexed: 02/06/2023]
Abstract
Decompression or healing chambers between the threads have been proposed to improve and accelerate the osseointegration process of dental implants. The aim of the present work was to test, in an in vivo sheep study, if healing chambers between the threads could produce a better osseointegration process. Thirty titanium implants (15 conventional design (control) and 15 implants with healing chambers (test)) were inserted in a random fashion in the tibia of 3 sheep. The animals were euthanized after 30 days of healing, and the retrieved specimens treated to obtain thin ground sections. Histological observations showed that the quantity of newly formed bone growing in an apical direction was lower in the control group (1095 µm) when compared to the Test group (1658 µm). This difference was statistically significant. Moreover, a layer of osteogenic matrix was present around the portion of implants immersed in the marrow spaces. This osteogenic tissue was thicker in the test group. In conclusion, the present study confirmed the very good results in implants with healing chambers that presented a higher percentage of new bone formation.
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Tabassum A, Meijer GJ, Cuijpers VMJI, Frank Walboomers X. Combined effect of undersized surgical technique and axial compression on the primary implant stability and host bone architecture. Saudi Dent J 2020; 33:283-291. [PMID: 34194192 PMCID: PMC8236550 DOI: 10.1016/j.sdentj.2020.03.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2019] [Revised: 03/05/2020] [Accepted: 03/08/2020] [Indexed: 12/11/2022] Open
Abstract
Aim The aim of this study was to investigate the combined effect of the lateral-compression of host-bone (undersized-osteotomy-preparation) and axial-compression of host-bone (not drilling the full length of the implant) on the primary-implant-stability and the host-bone-architecture. Materials and Methods In this experimental-study, 44 dental implants (diameter-4.2 mm; length-10 mm; Dyna®) were installed in the femoral-condyles of four cadaver-goats using four different surgical approaches (11 implant/surgical approach; n = 11). Approach-1: Standard preparation according to the manufacturer's guidelines. The bone-cavity was prepared up to 10 mm in depth and 4 mm in diameter. Approach-2: Preparation up to 8 mm in depth and 4 mm in diameter. Approach-3: Preparation up to 10 mm in depth. Approach-4: The bone-cavity was prepared up to 8 mm in depth and 3.6 mm in diameter. Insertion torque (n = 11), removal torque (n = 7) and % bone-implant contact (n = 4) measurements were recorded. Bone architecture was assessed by micro-computer tomography and histological analysis (n = 4). Results For approaches 2, 3, and 4 (P < .05), insertion-torque values were significantly higher as compared to approach 1. Regarding the bone-implant-contact percentage (%BIC), approach 3 and 4 were significantly higher compared to approach 1 and 2 (P<.05). For approach 2, the %bone volume (%BV) was significantly higher as compared to approach 1 (P<.05) for the most the inner zone of host bone in proximity of the implant. Conclusion Lateral and axial compression improved the primary-implant-stability and therefore this new surgical-technique should be considered as an alternative approach especially for placing implants in low-density bone. Nevertheless, additional in vivo studies should be performed.
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Affiliation(s)
- Afsheen Tabassum
- Department of Preventive Dentistry, Imam Abdulrahman Bin Faisal University, College of Dentistry Dammam, Saudi Arabia
| | - Gert J Meijer
- Department of Implantology & Periodontology, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands.,Department of Oral and Maxillofacial Surgery, Radboud University Nijmegen Medical Centre, Nijmegen, the Netherlands
| | - Vincent M J I Cuijpers
- Department of Biomaterials, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - X Frank Walboomers
- Department of Biomaterials, Radboud University Medical Centre, Nijmegen, the Netherlands
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Modified surgical drilling protocols influence osseointegration performance and predict value of implant stability parameters during implant healing process. Clin Oral Investig 2020; 24:3445-3455. [PMID: 31989368 DOI: 10.1007/s00784-020-03215-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Accepted: 01/16/2020] [Indexed: 10/25/2022]
Abstract
OBJECTIVE The aim of this study was to evaluate the effects of three different surgical drilling protocols on changes of implant stability parameters and osseointegration performance during the healing period in rabbit femoral condyles. MATERIAL AND METHODS Thirty New Zealand white rabbits were used in this study. Three experimental groups according to different surgical drilling protocols (undersized, standard and oversized preparation) were designed. Measurements of implant stability parameters were performed immediately after implant insertion and then at 1, 2, 4, and 8 weeks after the operation. After the animals were sacrificed, the bone blocks with implant were prepared for histological evaluation and histomorphometric analysis. RESULTS The results demonstrated that the ISQ values of each group increased gradually through the whole healing period, while the damping factor showed the opposite tendency. The histomorphometric analysis revealed that BIC (bone-implant contact) values gradually increased with time until 8 weeks of healing at each group. In addition, the undersized group has the highest initial BIC (25.16% ± 7.25%) and the lowest values were found in oversized group (9.13% ± 5.89%). Moreover, a higher correlation (R2 = 0. 9817) between ISQ and BIC values in oversized group and moderate correlations between DF and BIC values in undersized group (R2 = 0.823) were demonstrated. CONCLUSIONS The undersized drilling protocol group presented the highest implant stability and BIC values in the whole healing period, while the similar tendency of results was found between standard and oversized drilling protocol groups. CLINICAL RELEVANCE These results suggested that undersized drilling protocol is mechanically and biologically beneficial in low-density bone. The modifications of surgical drilling protocols would influence the predictive value of implant stability parameters for osseointegration performance.
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Bonfante EA, Jimbo R, Witek L, Tovar N, Neiva R, Torroni A, Coelho PG. Biomaterial and biomechanical considerations to prevent risks in implant therapy. Periodontol 2000 2019; 81:139-151. [PMID: 31407440 DOI: 10.1111/prd.12288] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
This paper is aimed to present a biomaterials perspective in implant therapy that fosters improved bone response and long-term biomechanical competence from surgical instrumentation to final prosthetic rehabilitation. Strategies to develop implant surface texturing will be presented and their role as an ad hoc treatment discussed in light of the interplay between surgical instrumentation and implant macrogeometric configuration. Evidence from human retrieved implants in service for several years and from in vivo studies will be used to show how the interplay between surgical instrumentation and implant macrogeometry design affect osseointegration healing pathways, and bone morphologic and long-term mechanical properties. Also, the planning of implant-supported prosthetic rehabilitations targeted at long-term performance will be appraised from a standpoint where personal preferences (eg, cementing or screwing a prosthesis) can very often fail to deliver the best patient care. Lastly, the acknowledgement that every rehabilitation will have its strength degraded over time once in function will be highlighted, since the potential occurrence of even minor failures is rarely presented to patients prior to treatment.
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Affiliation(s)
- Estevam A Bonfante
- Department of Prosthodontics and Periodontology, University of São Paulo Bauru School of Dentistry, Bauru, Brazil
| | - Ryo Jimbo
- Department of Applied Prosthodontics, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan
| | - Lukasz Witek
- Department of Biomaterials, New York University, New York City, New York, USA
| | - Nick Tovar
- Department of Biomaterials, New York University, New York City, New York, USA
| | - Rodrigo Neiva
- Department of Periodontology, University of Florida at Gainesville, Gainesville, Florida, USA
| | - Andrea Torroni
- Attending Oral and Maxillofacial Surgery, Hansjörg Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York City, New York, USA
| | - Paulo G Coelho
- Department of Biomaterials, Hansjörg Wyss Department of Plastic Surgery, Mechanical and Aerospace Engineering, New York University, New York City, New York, USA
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Del Giudice R, Piattelli A, Grande NM, Cataneo E, Crispino A, Petrini M. Implant insertion torque value in immediate loading: A retrospective study. Med Oral Patol Oral Cir Bucal 2019; 24:e398-e403. [PMID: 31011142 PMCID: PMC6530943 DOI: 10.4317/medoral.22845] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2018] [Accepted: 03/01/2019] [Indexed: 11/05/2022] Open
Abstract
BACKGROUND The aim of this study is to verify if the Insertion Torque Value (ITV) of 32 Ncm for immediate loading protocol (ILP), as indicated by literature, is still, with the advance in implant research, a real significant cut-off for long-term implant survival. MATERIAL AND METHODS In this retrospective study, data from 224 patients that during three years of clinical practice, were submitted to the insertion of 322 implants with immediate loading protocol, have been recorded, pooled and analyzed. Data were organized based on Insertion Torque Value (ITV): > 32 Ncm (CG) and < 32 Ncm (LTG) and two different groups of equal sample size, 161 implants each, were distinguished. Crestal bone reabsorption, and the implant failure rate were evaluated after 2-years of follow-up. RESULTS The bone reabsorption in LTG (0.49 ± 0.11 mm ) was significantly greater than CG (0.22 ± 0.04 mm), p<0.001. However, the survival rate after 2-years of follow-up was quite high and similar for both groups: 96.89% for LTG and 97.52% for CG and no statistically significant differences have been found among the two groups for the implant failure rate (p=0.455).The Odds Ratio (OR) of implant failure was of 1.258 (95% CI 0.332, 4.772), but results were not statistical significant, p=0.740. CONCLUSIONS The present study showed that although implants with ITV> 32 Ncm are still characterized by a lower crestal bone resorption, there are no statistically significant differences among the two groups for what concerning the failure rate during the 2 years of follow-up and OR. These results permit us to suppose that the cut-off of ITV >32 Ncm for immediate loading implants, could be reduced to inferior values. However further studies are necessary to indicate precise clinical guidelines.
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Affiliation(s)
- R Del Giudice
- Department of Medical Oral and Biotechnological Sciences, University of Chieti - Italy, Address: Via Vestini 31, 66013 Chieti, Italy,
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Jokstad A, Ganeles J. Systematic review of clinical and patient-reported outcomes following oral rehabilitation on dental implants with a tapered compared to a non-tapered implant design. Clin Oral Implants Res 2019; 29 Suppl 16:41-54. [PMID: 30328207 DOI: 10.1111/clr.13128] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/05/2018] [Indexed: 11/30/2022]
Abstract
BACKGROUND Dental implants are available in different shapes. AIMS This systematic review aims to address whether tapered compared to non-tapered implants demonstrate similar clinical and patient-reported outcomes. The review follows the preferred reporting items for systematic reviews and meta-analyses (PRISMA) format. MATERIALS & METHODS We searched electronic databases including MEDLINE through PubMed and the Cochrane Central Register of Controlled Trials for randomized clinical trials (RCT) that compare tapered versus non-tapered implants with at least 10 treated participants and a minimum mean follow-up time of 3 years. There were no restrictions to a particular treatment indication or outcome measures. Two authors independently conducted screening, risk of bias assessment, and data extraction of eligible trials in duplicate. We applied the Cochrane risk of bias assessment tool to consider risk of bias. RESULTS We identified 18 different RCTs, of which three reported outcomes at 3 years or greater. The three trials described the results of 245 participants with 388 implants at 3 years, from the initially 306 participants with 494 implants at baseline. The three trials compared, respectively, two, two, and three different commercially available implant brands and reported only clinically insignificant differences. We judged all three trials to be at moderate risk of bias. The low number and heterogeneity of RCTs did not allow for meta-analyses. DISCUSSION AND CONCLUSION Appropriate professional judgment in clinical decision making must include a comprehensive diagnosis of the patient's jawbone quality and quantity and consideration of osteotomy protocol in accordance with the patient's treatment preferences, where the shape of the dental implant is only one contributory factor.
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Affiliation(s)
- Asbjørn Jokstad
- Faculty of Health Sciences, UiT The Arctic University of Norway, Tromsø, Norway
| | - Jeffrey Ganeles
- South Florida Center for Periodontics & Implant Dentistry, Boca Raton, FL, USA.,Nova Southeastern University College of Dental Medicine, Ft. Lauderdale, FL, USA
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Marconcini S, Giammarinaro E, Toti P, Alfonsi F, Covani U, Barone A. Longitudinal analysis on the effect of insertion torque on delayed single implants: A 3-year randomized clinical study. Clin Implant Dent Relat Res 2018; 20:322-332. [DOI: 10.1111/cid.12586] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2017] [Revised: 12/19/2017] [Accepted: 01/04/2018] [Indexed: 12/25/2022]
Affiliation(s)
- Simone Marconcini
- Department of Surgical, Medical, Molecular and Critical Area Pathology; University of Pisa; Pisa Italy
| | - Enrica Giammarinaro
- Department of Surgical, Medical, Molecular and Critical Area Pathology; University of Pisa; Pisa Italy
| | - Paolo Toti
- Department of Surgical, Medical, Molecular and Critical Area Pathology; University of Pisa; Pisa Italy
| | - Fortunato Alfonsi
- Department of Surgery and Translational Medicine; University of Florence; Florence Italy
| | - Ugo Covani
- Department of Surgical, Medical, Molecular and Critical Area Pathology; University of Pisa; Pisa Italy
| | - Antonio Barone
- Unit of Oral Surgery and Implantology, University-Hospital at Geneva, Department of Surgery; School of Dental Medicine; Geneva Switzerland
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The Effect of Osteotomy Dimension on Implant Insertion Torque, Healing Mode, and Osseointegration Indicators: A Study in Dogs. IMPLANT DENT 2017; 25:739-743. [PMID: 27513163 DOI: 10.1097/id.0000000000000476] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE This study investigated the effect of the osteotomy diameter for implant placement torque and its effect on the osseointegration. MATERIALS AND METHODS Eight male beagle dogs received 48 implants (3.75 mm × 10 mm) in their right and left radius, 3 implants per side and allowed to heal for 3 weeks. Three experimental groups were evaluated. Group 1: implant with an undersized osteotomy of 3.0 mm; group 2: osteotomy of 3.25 mm, and group 3: osteotomy of 3.5 mm. The insertion torque was recorded for all implants. Histological sectioning and histometric analysis were performed evaluating bone-to-implant contact (BIC) and bone area fraction occupancy (BAFO). RESULTS Implants of group 1 presented statistically higher insertion torque than those of groups 2 and 3 (P < 0.01). No differences in BIC or BAFO were observed between the groups. From a morphologic standpoint, substantial deviations in healing mode were observed between groups. CONCLUSION Based on the present methodology, the experimental alterations of surgical technic can be clinically used with no detrimental effect over the osseointegration process.
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The Effects of High Insertion Torque Versus Low Insertion Torque on Marginal Bone Resorption and Implant Failure Rates: A Systematic Review With Meta-Analyses. IMPLANT DENT 2017; 25:532-40. [PMID: 27129002 DOI: 10.1097/id.0000000000000422] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022]
Abstract
OBJECTIVES The aim was to analyze the data about the effects on marginal bone resorption and implant failure rates between implants inserted with high or low insertion torque values. MATERIALS AND METHODS A systematic literature search until July 2015 was conducted. Data were summarized qualitatively in descriptive tables and quantitatively by performing random effects meta-analyses of effect sizes (ESs) for bone resorption and bone-to-implant contact (BIC) and relative risks (RRs) for implant failures. Risk of bias assessments were performed using the Cochrane tool for human studies and the SYRCLE's tool for animal studies. RESULTS Four studies in humans and 6 quasirandomized animal studies were included. A total of 591 implants were evaluated qualitatively: 348 installed with high insertion torque (>25 Ncm, up to 176 Ncm) and 243 implants inserted with low torque values (<30-35 Ncm). No significant differences were detected for bone resorption (ES, 0.13; 95% confidence interval [CI], -0.12 to 0.38 in human studies; ES predictive interval from 35.03 to 34.50 in animal studies), implant failure (RR, 0.39; 95% CI, 0.01-20.77 in human studies; RR, 2.05; 95% CI, 0.19-21.71 in animal studies), or BIC (ES predictive interval from -3.84 to 5.13 in animal studies). CONCLUSION The current review indicated that there is no significant difference in marginal bone resorption and implant failure rate between implants inserted with high or low insertion torque values.
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Insua A, Monje A, Wang HL, Miron RJ. Basis of bone metabolism around dental implants during osseointegration and peri-implant bone loss. J Biomed Mater Res A 2017; 105:2075-2089. [DOI: 10.1002/jbm.a.36060] [Citation(s) in RCA: 104] [Impact Index Per Article: 14.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2016] [Revised: 03/01/2017] [Accepted: 03/03/2017] [Indexed: 12/18/2022]
Affiliation(s)
- Angel Insua
- Department of Periodontics and Oral Medicine; The University of Michigan; Ann Arbor Michigan
| | - Alberto Monje
- Department of Periodontics and Oral Medicine; The University of Michigan; Ann Arbor Michigan
| | - Hom-Lay Wang
- Department of Periodontics and Oral Medicine; The University of Michigan; Ann Arbor Michigan
| | - Richard J. Miron
- Department of Periodontology; Nova Southeastern University; Fort Lauderdale Florida
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Osseointegration of Plateau Root Form Implants: Unique Healing Pathway Leading to Haversian-Like Long-Term Morphology. ADVANCES IN EXPERIMENTAL MEDICINE AND BIOLOGY 2015; 881:111-28. [PMID: 26545747 DOI: 10.1007/978-3-319-22345-2_7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Endosteal dental implants have been utilized as anchors for dental and orthopedic rehabilitations for decades with one of the highest treatment success rates in medicine. Such success is due to the phenomenon of osseointegration where after the implant surgical placement, bone healing results into an intimate contact between bone and implant surface. While osseointegration is an established phenomenon, the route which osseointegration occurs around endosteal implants is related to various implant design factors including surgical instrumentation and implant macro, micro, and nanometer scale geometry. In an implant system where void spaces (healing chambers) are present between the implant and bone immediately after placement, its inherent bone healing pathway results in unique opportunities to accelerate the osseointegration phenomenon at the short-term and its maintenance on the long-term through a haversian-like bone morphology and mechanical properties.
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