Can the design of the instruments used for undersized osteotomies influence the initial stability of implants installed in low-density bone? An in vitro pilot study

Analysis of osseointegration of implants with macrogeometries with healing chambers: a randomized clinical trial

BACKGROUND

To verify the influence of macrogeometry with healing chambers on the osseointegration of dental implants by analyzing implant stability quotient (ISQ) and evaluate the correlation between insertion torque and ISQ insertion with different macrogeometries.

METHODS

In total, 26 implants were installed in the posterior mandible of eight patients with sufficient bone height for the installation of implants measuring 3.5 mm in diameter and 9.0 mm in length. The implants were categorized according to two types of macrogeometry: a test group (GT) with 13 conical implants with healing chambers and a control group (GC) with 13 conical implants with conventional threads. To insert the implants, a bone drilling protocol was used up to a diameter of 3 mm with the last helical bur. The insertion torque of the implants was evaluated, followed by the measurement of ISQ at 0 (T-0), 7 (T-7), 14 (T-14), 21 (T-21), 28 (T-28), and 42 (T-42) days.

RESULTS

The mean insertion torque was 43 Ncm in both groups, without a significant difference. Moreover, no significant difference in the ISQ values was found between the groups at different time points (p > 0.05), except at T-7 (GT = 69.87±1.89 and GC = 66.48±4.49; p = 0.01). Although there was no significant difference, ISQ median values were higher in the GT group than GC group at 28 days (GT = 67.98 and GC = 63.46; p = 0.05) and 42 days (GT = 66.12 and GC = 60.33; p = 0.09). No correlation was found between the insertion torque and ISQ insertion (p > 0.05).

CONCLUSION

Furthermore, implants with a 3.5 mm diameter macrogeometry, with or without healing chambers, inserted with a drilling protocol up to 3 mm in diameter of the last helical bur, led to a similar secondary stability, with no difference in ISQ values. Although, implants with healing chamber demonstrates ascending values in the graph of ISQ, having a trend of faster osseointegration than implants without healing chambers. Both macrogeometries provide a similar primary stability to implants.

TRIAL REGISTRATION

This study was registered retrospectively in ReBec (brazilian registry of clinical trials) under the number RBR-96n5×69, on the date of 19/06/2023.

The past forty-three years of dental implantology literature. A global mapping and scientometric analysis

PURPOSE

The aim of this research is to make a scientometric analysis of the dental implantology literature and to present the results in a more understandable way to the reader by visualizing them with maps.

METHODS

The dental implantology literature was accessed through the Web of Science database. Scientometric data was obtained with Citespace 6.1 software, co-citation, clustering analysis, citation burst, and mapping analyzes were performed. Scimago Graphica software was used for additional visualizations.

RESULTS

A total of 35,704 articles were included in the analysis. There were 88,616 authors, 72,333 institutes, 142 countries/regions, and 3,265 journals contributing to the dental implantology literature. The United States was first with 7,334 publications and 225,868 citations. The literature between 1980 and 2023 was divided into 19 different clusters, and the literature between 2000 and 2023 was divided into 16 different clusters.

CONCLUSIONS

Key themes in the field include the use of autogenous bone, advancements in implant surface technology, and the use of platform switching and intraoral scanners. Emerging topics of interest include esthetic considerations in the treatment of the anterior region, stress distribution, the use of zirconia, and the impact of implant treatment on oral health-related quality of life. With similar scientometric analysis studies to be done in the future, the progress of the literature can be followed on the basis of evidence.

Primary stability evaluation of different morse cone implants in low-density artificial bone blocks: A comparison between high-and low-speed drilling

This study aimed to evaluate various biomechanical parameters associated with the primary stability of Maestro and Due Cone implants placed in low-density artificial bones, prepared using high-speed drilling with irrigation and low-speed drilling without irrigation. The insertion torque (IT), removal torque (RT), and implant stability quotient (ISQ) values were recorded for Maestro and Due Cone implants placed in low-density polyurethane blocks (10 and 20 pounds per cubic foot (PCF) with and without a cortical layer) prepared using high-speed and low-speed with or without irrigation using a saline solution, respectively. A three-way ANOVA model and Tukey's post-hoc test were conducted, presenting data as means and standard deviations. P-values equal to or less than 0.05 were considered statistically significant. No statistically significant differences in IT, RT, and ISQ between drilling speeds were observed. However, Maestro implants exhibited lower IT and RT values after high- and low-speed drilling across almost all polyurethane blocks, significantly evident in the 20 PCF density block for IT and in the 20 PCF density block with the cortical layer for the RT with low-speed drilling (IT: 47.33 ± 10.02 Ncm and 16.00 ± 12.49 Ncm for Due Cone and Maestro implants, respectively, with p < 0.01; RT: 44.67 ± 22.81 Ncm and 20.01 ± 4.36 Ncm for Due Cone and Maestro implants, respectively, with p < 0.05) and among the same implant types inserted in different bone densities. Additionally, the study found that for all bone densities and drilling speeds, both implants registered ISQ values exceeding 60, except for the lowest-density polyurethane block. Overall, it can be inferred that low-speed drilling without irrigation achieved biomechanical parameters similar to conventional drilling with both implant types, even with lower IT values in the case of Maestro implants. These findings suggest a promising potential use of low-speed drilling without irrigation in specific clinical scenarios, particularly when focusing on preparation depth or when ensuring proper irrigation is challenging.

New strategy for osseodensification during osteotomy in low-density bone: an in vitro experimental study

The goal of this in vitro study was to evaluate and propose a new strategy for osseodensification technique using a drill counterclockwise to densification of bone of low density. Synthetic bone blocks of two different low densities (type III and IV) were used for the tests. The conventional drilling group (CD group) used Turbo-drill in a clockwise direction, and the osseodensification group (OD group) applied Turbo-drill in a counterclockwise direction. The applied tests were: (i) measurement of the temperature variation (ΔT) and (ii) measurement of the torque during the osteotomies, comparing the new strategy with the conventional drilling. Both groups were tested without (condition c1) and with (condition c2) irrigation, generating four subgroups: CDc1, CDc2, ODc1, and ODc2. Twenty osteotomies were made for each subgroup with a thermocouple positioned intra-bone (1 mm distant from the osteotomy) to measure the temperature produced. Other 20 samples/group were used to measure the torque value during each osteotomy in both synthetic bone density blocks. The mean of the ΔT during the osteotomies in type III bone was: 6.8 ± 1.26 °C for the CDc1 group, 9.5 ± 1.84 °C for the ODc1, 1.5 ± 1.35 °C for the CDc2, and 4.5 ± 1.43 °C for ODc2. Whereas, in the type IV bone, the ΔT was: 5.2 ± 1.30 °C for the CDc1 group, 7.0 ± 1.99 °C for the ODc1, 0.9 ± 1.05 °C for the CDc2, and 2.7 ± 1.30 °C for ODc2. The maximum torque during the osteotomies was: 8.8 ± 0.97 Ncm for CD samples and 11.6 ± 1.08 Ncm for OD samples in the type III bone; and 5.9 ± 0.99 Ncm for CD samples and 9.6 ± 1.29 Ncm for OD samples in the type IV bone. Statistical differences between the groups were detected in tests and conditions analyzed (p < 0.05). Using the drill counterclockwise for osseodensification in low-density bone generated a significantly greater torque of a drill than in CD and temperature variation during osteotomies. However, the temperature range displayed by the OD group was below critical levels that can cause damage to bone tissue.

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

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

Effects of Osseodensification on Immediate Implant Placement: Retrospective Analysis of 211 Implants

Osseodensification is a new method of bone instrumentation for dental implant placement that preserves bulk bone and increases primary implant stability, and may accelerate the implant rehabilitation treatment period and provide higher success and survival rates than conventional methods. The aim of this retrospective study was to evaluate and discuss results obtained on immediate implant placement with immediate and delayed loading protocols under Osseodensification bone instrumentation. This study included private practice patients that required dental implant rehabilitation, between February 2017 and October 2019. All implants were placed under Osseodensification and had to be in function for at least 12 months to be included on the study. A total of 211 implants were included in the study, with a 98.1% total survival rate (97.9% in the maxilla and 98.5% in the mandible). For immediate implants with immediate load, 99.2% survival rate was achieved, and 100% survival rate for immediate implant placement without immediate load cases. A total of four implants were lost during this period, and all of them were lost within two months after placement. Within the limitations of this study, it can be concluded that Osseodensification bone instrumentation provided similar or better results on survival rates than conventional bone instrumentation.