Predicting primary stability of orthodontic mini‐implants, according to position, screw‐size, and bone quality, in the maxilla of aged patients: a cadaveric study

The Importance of Correlation between CBCT Analysis of Bone Density and Primary Stability When Choosing the Design of Dental Implants—Ex Vivo Study

This study aims to determine the correlation between the mean value of bone density measured on the CBCT device and the primary stability of dental implants determined by resonant frequency analysis. An experimental study was conducted on a material of animal origin: bovine femur and pig ribs. Two types of implants were used in this study: self-tapping and non-self-tapping of the same dimensions. Results of the experimental study showed a statistically significant correlation between bone density expressed in HU units and the primary stability of self-tapping and non-self- tapping dental implants expressed in ISQ units in bovine femur bones and self-tapping implants and pig rib bones. There was no statistically significant correlation between non-self-tapping dental implants in pig rib bones. Self-tapping and non-self-tapping implants did not show statistical significance in the primary stability in bones of different qualities. The analysis of bone density from CBCT images in the software of the apparatus expressed in HU units can be used to predict the degree of primary stability of self-tapping and non-self-tapping dental implants in bones of densities D1 and D2, and self-tapping dental implants in bones of the lower quality D4.

The primary stability of two dental implant systems in low-density bone

Primary stability in low-density bone is crucial for the long-term success of implants. Tapered implants have shown particularly favourable properties under such conditions. The aim of this study was to compare the primary stability of tapered titanium and novel cylindrical zirconia dental implant systems in low-density bone. Fifty implants (25 tapered, 25 cylindrical) were placed in the anterior maxillary bone of cadavers meeting the criteria of low-density bone. The maximum insertion (ITV) and removal (RTV) torque values were recorded, and the implant stability quotients (ISQ) determined. To establish the isolated influence of cancellous bone on primary stability, the implantation procedure was performed in standardized low-density polyurethane foam bone blocks (cancellous bone model) using the same procedure. The primary stability parameters of both implant types showed significant positive correlations with bone density (Hounsfield units) and cortical thickness. In the cadaver, the cylindrical zirconia implants showed a significantly higher mean ISQ when compared to the tapered titanium implants (50.58 vs 37.26; P < 0.001). Pearson analysis showed significant positive correlations between ITV and ISQ (P = 0.016) and between RTV and ISQ (P = 0.035) for the cylindrical zirconia implants; no such correlations were observed for the tapered titanium implants. Within the limitations of this study, the results indicate that cylindrical zirconia implants represent a comparable viable treatment option to tapered titanium implants in terms of primary implant stability in low-density human bone.

Influence of bone density, screw size and surgical procedure on orthodontic mini-implant placement - part B: implant stability

This in vitro study aimed to investigate the influence of bone density, implant size, and surgical procedure on the primary stability (PS) of orthodontic mini-implants (OMIs). In total, 640 OMIs of various sizes (2.0 × 7, 2.3 × 7, 2.0 × 11 and 2.3 × 11 mm) were inserted in the artificial bone of different densities (D1-D4). Placement was performed with an insertion angle of 90° or 60° to the bone surface and in 320 cases without predrilling, which resulted in 64 groups. PS was measured on the basis of implant stability quotient (ISQ) and insertion torque (IT). With regard to all possible influencing parameters, the mean PS differed between 39.20 and 60.00 (ISQ), and 10.00 and 39.00 Ncm (IT). The effect of OMI size and surgical procedure was dependent on bone quality. For example, implant size had less effect in high-density bone and was stronger with decreasing density. Overall, implant length had a greater influence than the diameter, and a high correlation was found among both PS measurement techniques. Therefore, a suitable choice of implant size and surgical protocol with regard to bone density can positively influence PS. In principle, ISQ and IT are suitable for measuring OMI stability.

Influence of bone density, screw size and surgical procedure on orthodontic mini-implant placement - part A: temperature development

The aim of this in vitro study was to determine the influence of bone density, orthodontic mini-implant (OMI) size, and the surgical procedure on temperature increase during implant site osteotomy and placement. OMIs of different sizes (2.0×7, 2.3×7, 2.0×11, and 2.3×11mm) were placed in artificial bone blocks of different densities (D1-D4). Optionally, the drilling and insertion angle was 90° or 60° to the bone surface. A total of 640 OMIs were inserted, and predrilling was performed in 320 cases. All insertions were done without irrigation with an axial load of 20N, which resulted in 64 groups. Temperature measurements were performed during implant site preparation and placement using Type-K-thermocouples. Mean temperature increase differed for OMI osteotomy between 1.38°C and 8.75°C and placement between 3.8°C and 18.74°C, respectively. Critical thermal increase was especially reached during placement using long implants. Increasing bone density and implant size (diameter <length) correlated with thermal increase. Predrilling and angulated implant placement resulted in less heat development. Critical temperature behaviour in high-density bone could be partially responsible for the high failure rates of OMI placement in the lower jaw. The influence of the implant size on temperature development should be considered when selecting an OMI.

Suitability of virtual plaster models superimposed with the lateral cephalogram for guided paramedian orthodontic mini-implant placement with regard to the bone support

PURPOSE

The purpose of this study was twofold: first, to evaluate the precision of guided orthodontic mini-implant (OMI) placement planned on virtual superimposition of plaster models and lateral cephalograms with regard to the bone support and, second, to investigate the effects of silicone guide extension.

METHODS

A total of 40 OMIs were placed in the paramedian area of the anterior palates of 20 cadaver heads. Digitalized models and the corresponding lateral cephalograms were superimposed for planning the OMI positions, and tooth-supported (TS) and soft-tissue-supported (STS) templates were manufactured. Thereafter, postoperative cone beam computed tomography (CBCT) was performed, and the straight (A) and right-angle distance (B) from the implant tip to the nasal floor, the distance from the implant shoulder to the hard palate (C) and the angle (α) between the implant and palate plane with the preoperative (T0) and postoperative (T1) positions were measured.

RESULTS

The postoperative distances A, B, and C were less than the planned implant positions. However, significant difference between T0 and T1 was only noted in terms of distance A using the TS templates (T0: 4.7 ± 2.3 mm, T1: 3.0 ± 2.3 mm; p = 0.008) and distance B using the STS template (T0: 3.1 ± 3.5 mm, T1: 2.3 ± 3.2 mm; p = 0.041). There were no significant differences in all average deviations (∆ Ceph/CBCT) between the two templates.

CONCLUSIONS

Guided OMI placement planned by virtual superimposition of digitized models and the corresponding lateral cephalogram is fundamentally feasible. However, the position closer to the nasal floor needs critical assessment for correct implantation. The silicone template expansion seems to have only a minor effect on transfer accuracy.

Anatomical assessment by cone beam computed tomography with the use of lateral cephalograms to analyse the vertical bone height of the anterior palate for orthodontic mini-implants

OBJECTIVE

Lateral cephalograms (LC) should be usable to evaluate the vertical bone height of the anterior maxilla for planning the placement of orthodontic mini-implants (OMI). The purpose of this study is to determine the usability of LC for examining the real vertical dimension of the anterior palate.

SETTING AND SAMPLE POPULATION

Lateral cephalograms and corresponding cone beam computed tomography (CBCT) scans were employed for examining 30 fresh cadaver heads.

MATERIALS & METHODS

The minimum (distance A) and maximum (distance B) vertical palatal bone heights on LCs at the level of first premolars were measured, whereas the corresponding measurements were taken via CBCTs on the median, and 2-, 4- and 6-mm paramedian planes. Additionally, the overall minimum vertical palatal height on CBCT was recorded.

RESULTS

Distance A and B on LC were about 8.3 ± 2.5 mm and 9.9 ± 2.5 mm, respectively. The median palatal height on CBCT was significantly higher than both measurements on LC (P < .01). Furthermore, the bone supply on the paramedian planes was similar or higher on CBCT compared to Distance A and similar or less compared to Distance B. The strongest correlation at the level of the premolars was found in the comparison of the maximum vertical palatal height via LC with the vertical palatal height on the median plane via CBCT (r = .84, 95% CI: 0.69-0.92, P < .001).

CONCLUSIONS

In order to make the best possible use of the vertical bone supply of the anterior palate and to avoid injuries to the nasal floor, Distance A should be taken into account for planning paramedian OMI placements and distance B for median OMI insertion.

Assessment of the cortical bone thickness by CT-scan and its association with orthodontic implant position in a young adult Eastern Mediterranean population: A cross sectional study

OBJECTIVE

This study was conducted to assess cortical bone thickness in the alveolar process of maxilla and mandible and to investigate its association with different orthodontic implant positions in Eastern Mediterranean young adults.

MATERIALS AND METHODS

Computed tomography images of 50 patients aged between 18-35 years were included. Buccal, palatal and lingual cortical bone thicknesses were measured at 2, 4, 6, and 8mm from cemento-enamel junction starting from the mesial side of the second molar to the contralateral side. Pearson correlation was used to assess the association between cortical bone thickness and proposed orthodontic implant positions at all inter-radicular sites (p<0.05).

RESULTS

The highest value of buccal cortical bone thickness was found mesial to the second molar in the maxilla and mandible for both genders. The value of palatal cortical bone thickness was found to be at the highest rate mesial to canine and first premolar in males and females respectively. On the other hand, the highest value of lingual cortical bone thickness was recorded to be mesial to the first molar in both genders. In addition to that, the buccal cortical bone thickness was significantly higher than palatal at the area mesial to the second molar at all four levels from the cemento-enamel junction. A significant correlation was found between cortical bone thickness and 2, 4, 6, and 8mm orthodontic implant levels in all inter-radicular sites. The values of correlation coefficients ranged from 0.280 to 0.674 in the maxillary arch and from 0.266 to 0.605 in the mandibular arch.

CONCLUSIONS

From this study, we can conclude that as the position of the orthodontic implant moved more posteriorly and apically more cortical bone thickness was expected to be found in both jaws. A significant correlation was found between cortical bone thickness and the site of the orthodontic implant. Cortical bone thickness and its relationship with implant position should be taken into consideration when attempts are made to insert the orthodontic implant.