Primary Stability of Three Different Osteotomy Techniques in Medullary Bone: An in Vitro Study

Evaluation of the accuracy of fully guided implant placement by undergraduate students and postgraduate dentists: a comparative prospective clinical study

PURPOSE

This study aimed to assess the accuracy of implant placement through three-dimensional planning and fully guided insertion, comparing outcomes between undergraduate and postgraduate surgeons.

METHODS

Thirty-eight patients requiring 42 implants in posterior single-tooth gaps were enrolled from the University Clinic for Prosthodontics at the Martin Luther University Halle Wittenberg and the Department of Prosthodontics, Geriatric Dentistry, and Craniomandibular Disorders of Charité University Medicine, Berlin. Twenty-two implants were placed by undergraduate students (n = 18), while 20 implants were placed by trainee postgraduate dentists (n = 5). Pre-operative intraoral scans and cone beam computed tomography images were performed for implant planning and surgical template fabrication. Postoperative intraoral scans were superimposed onto the original scans to analyze implant accuracy in terms of apical, coronal, and angular deviations, as well as vertical discrepancies.

RESULTS

In the student group, two implant insertions were performed by the assistant dentist because of intraoperative complications and, thus, were excluded from further analysis. For the remaining implants, no statistically significant differences were observed between the dentist and student groups in terms of apical (p = 0.245), coronal (p = 0.745), or angular (p = 0.185) implant deviations, as well as vertical discrepancies (p = 0.433).

CONCLUSIONS

This study confirms the viability of fully guided implant placement by undergraduate students, with comparable accuracy to postgraduate dentists. Integration into dental education can prepare students for implant procedures, expanding access and potentially reducing costs in clinical practice. Collaboration is essential for safe implementation, and future research should explore long-term outcomes and patient perspectives, contributing to the advancement of dental education and practice.

TRIAL REGISTRATION

DRKS, DRKS00023024, Registered 8 September 2020-Retrospectively registered, https://drks.de/search/de/trial/DRKS00023024 .

Effect of Implant Macro-Design and Magnetodynamic Surgical Preparation on Primary Implant Stability: An In Vitro Investigation

BACKGROUND

Macro-geometry and surgical implant site preparation are two of the main factors influencing implant stability and potentially determining loading protocol. The purpose of this study was to assess the initial stability of various implant macro-designs using both magnetodynamic and traditional osteotomy techniques in low-density bone. The parameters examined included peak insertion torque (PIT), implant stability quotient (ISQ), and peak removal torque (PRT).

METHODS

Four groups of 34 implants each were identified in accordance with the surgery and implant shape: T5 group (Five implant and osteotomy using drills); M5 group (Five implant and magnetodynamic osteotomy using Magnetic Mallet); TT group (TiSmart implant and osteotomy with drills); and MT group (TiSmart implant and magnetodynamic osteotomy). Every implant was placed into a low-density bone animal model and scanned using CBCT. The PIT and PRT were digitally measured in Newton-centimeters (Ncm) using a torque gauge device. The ISQ was analyzed by conducting resonance frequency analysis.

RESULTS

The PIT values were 25.04 ± 4.4 Ncm for T5, 30.62 ± 3.81 Ncm for M5, 30 ± 3.74 Ncm for TT, and 32.05 ± 3.55 Ncm for MT. The average ISQ values were 68.11 ± 3.86 for T5, 71.41 ± 3.69 for M5, 70.88 ± 3.08 for TT, and 73 ± 3.5 for MT. The PRT values were 16.47 ± 4.56 Ncm for T5, 26.02 ± 4.03 Ncm for M5, 23.91 ± 3.28 Ncm for TT, and 26.93 ± 3.96 Ncm for MT. Based on our data analysis using a t-test with α = 0.05, significant differences in PIT were observed between TT and T5 (p < 0.0001), M5 and T5 (p < 0.0001), and MT and TT (p = 0.02). Significant differences in the ISQ were found between TT and T5 (p = 0.001), M5 and T5 (p < 0.001), and MT and TT (p = 0.01). The PRT also exhibited significant differences between TT and T5, M5 and T5, and MT and TT (p < 0.0001).

CONCLUSION

Our data showed favorable primary implant stability (PS) values for both implant macro-geometries. Furthermore, the magnetodynamic preparation technique appears to be more effective in achieving higher PS values in low-density bone.

Investigating the impact of diameters and thread designs on the Biomechanics of short implants placed in D4 bone: a 3D finite element analysis

BACKGROUND

Dental implants emerge as a dependable and efficacious alternative for patients experiencing partial or complete tooth loss. The stability of these implants is influenced by surface topography and macro-level design. In cases where the height of the maxillary posterior region is diminished, employing short implants can prove advantageous. With the aim of examining the distribution of von Mises stress, strain, and micromovement in D4 bone quality surrounding platform-switched short implants, measuring 6 mm in length and featuring diameters ranging from 4 to 6 mm, as well as different thread designs, an in-depth finite element analysis was conducted under immediate loading conditions.

METHODOLOGY

A 3D finite element model was constructed to simulate maxillary molar crowns, incorporating an implant with a length of 6 mm and varying diameters and thread designs. The diameters utilized were 4/3.6 mm, 5/4 mm, and 6/4.8 mm, while the thread designs included buttress, square, and triangle patterns. Each model underwent analysis with a 100 N force applied in two directions: vertical and oblique, relative to the long axis of the implant. Stress, strain, and micromovement in the peri-implant region were recorded, employing the Ansys Workbench R v.18.1 software for modelling and analysis.

RESULTS

When comparing all three diameters, the wide diameter (6 mm threads) exhibited the lowest values of peri-implant von Mises stresses (3.3 MPa and 35.1 MPa), strains (194 Ɛ and 484 Ɛ), and micromovements (0.7 μm and 1.3 Ɛ) subjected to axial and non-axial loading of a 100 N force. Notably, square microthreads yielded the most favorable stress parameters among the different thread shapes, manifesting the minimum values of stress, strains, and micromovements in their vicinity.

CONCLUSION

For the treatment of atrophic ridges or in scenarios necessitating extensive surgical preparation of the implant site, a combination of short implants, wide diameters, and platform switching can be employed. In situations with reduced bone height and the requirement for an implant-supported prosthesis to replace a missing permanent maxillary molar, the utilization of wide-diameter platform-switched short implants measuring 6 mm in length, featuring a square thread design, should be taken into consideration.

Relevant Aspects of the Dental Implant Design on the Insertion Torque, Resonance Frequency Analysis (RFA) and Micromobility: An In Vitro Study

The major problems for the osseointegration of dental implants are the loosening of the screw that fixes the dental implant to the abutment and the micromovements that are generated when mechanical loads are applied. In this work, torque differences in the tightening and loosening of the connection screws after 1 cycle, 10 cycles and 1000 cycles for 4 dental implants with 2 external and 2 internal connections were analyzed. The loosening of 240 implants (60 for each system) was determined using high-precision torsimeters and an electromechanical testing machine. A total of 60 dental implants for each of the 4 systems were inserted into fresh bovine bone to determine the micromovements. The implant stability values (ISQ) were determined by RFA. The mechanical loads were performed at 30° from 20 N to 200 N. By means of the Q-star technique, the micromovements were determined. It was observed that, for a few cycles, the loosening of the screw did not exceed a loss of tightening of 10% for both connections. However, for 1000 cycles, the loss for the external connection was around 20% and for the internal connection it was 13%. The micromovements showed a lineal increase with the applied load for the implant systems studied. An external connection presented greater micromotions for each level of applied load and lower ISQ values than internal ones. An excellent lineal correlation between the ISQ and micromobility was observed. These results may be very useful for clinicians in the selection of the type of dental implant, depending on the masticatory load of the patient as well as the consequences of the insertion torque of the dental implant and its revisions.

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

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

Comparison of heat production and bone architecture changes in the implant site preparation with compressive osteotomes, osseodensification technique, piezoelectric devices, and standard drills: an ex vivo study on porcine ribs

This study aimed at investigating differences in heat generation and bone architecture following four different implant site preparation techniques: compressive osteotomes, conventional drills, osseodensification (OD mode with osseodensification drills), and piezoelectric systems. Porcine rib bones were used as a model for implant surgery. Thermocouples were employed to measure temperature changes, and micro-CT to assess the bone architecture. The primary stability and insertion torque values of the implants placed in the differently prepared sites were assessed. The temperature changes were higher with Piezo. The average primary stability using the ISQ scale was the greatest for drills (76.17 ± 0.90) and the lowest for osteotomes (71.50 ± 11.09). Insertion torque was significantly higher with the osseodensification method (71.67 ± 7.99 Ncm) in comparison to drills, osteotomes, and piezo. Osteotomes showed the highest bone to implant contact percentage (39.83 ± 3.14%) and average trabecular number (2.02 ± 0.21 per mm), while drills exhibited the lowest (30.73 ± 1.65%; 1.37 ± 0.34 per mm). Total implant site bone volume was the highest with osseodensification (37.26 ± 4.13mm³) and the lowest for osteotomes (33.84 ± 3.84mm³). Statistical analysis showed a high primary stability and decrease in temperature during implant site preparation with osseodensification technique. The results support the use of osseodensification technique for implant site preparation.

Are Torque-Induced Bone Texture Alterations Related to Early Marginal Jawbone Loss?

The reason why marginal bone loss (MBL) occurs after dental implant insertion without loading has not yet been clearly investigated. There are publications that confirm or reject the notion that there are factors that induce marginal bone loss, but no research investigates what exactly occurs in the bone surrounding the implant neck. In this study, 2196 samples of dental implant neck bone radiographs were analyzed. The follow-up period was 3 months without functional loading of the implant. Marginal bone loss was evaluated in relation to the torque used during the final phase of implant insertion. Radiographic texture features were also analyzed and evaluated. The analyses were performed individually for the anterior and posterior part of the alveolar crest in both the mandible and maxilla. After 3 months, an MBL relation with higher torque (higher than 40 Ncm; p < 0.05) was observed, but only in the lower jaw. The texture features Sum Average (SumAverg), Entropy, Difference Entropy (DifEntr), Long-Run Emphasis (LngREmph), Short-Run Emphasis (ShrtREmph), and discrete wavelet decomposition transform features were changed over time. This study presents that MBL is related to the torque value during dental implant insertion and the location of the procedure. The increasing values of SumAverg and LngREmph correlated with MBL, which were 64.21 to 64.35 and 1.71 to 2.01, respectively. The decreasing values of Entr, DifEntr, and ShrtREmph also correlated with MBL, which were 2.58 to 2.47, 1.11 to 1.01, and 0.88 to 0.84, respectively. The analyzed texture features may become good indicators of MBL in digital dental surgery.

Hybrid Funnel Technique: A Novel Approach for Implant Site Preparation: A Pilot Study

(1) Background: Different techniques and tools have been developed for implant site preparation. In this clinical scenario, Hybrid Funnel Technique (HFT), a novel osteotomy procedure, has been proposed. (2) Aim: The aim of this retrospective observational study was to consider the different responses to compression of the histological bony compartments (cancellus and cortical). HFT involves the use of multiple drills for the cortical layer preparation and of an osteotome for the osteocompaction of the cancellous bone. (3) Materials and Methods: Following computer-supported implant planning and guided surgery, 10 osteotomies with HFT were performed and 10 implants with the same length and diameter were placed in seven healthy and no daily smoking patients. Periapical X-ray and intraoral photographs were performed at baseline and after 12 months of follow-up to evaluate marginal bone level (MBL) changes and aesthetic results obtained from implant prosthetic rehabilitation. (4) Results: At 1 year of follow-up, 100% of the implants were successfully integrated, MBL change mean value was 0.17 mm ± 0.21. No differences in terms of MBL were noted between thin and thick biotypes. Pink esthetic score (PES) and white esthetic score (WES), assessed one year after definitive restoration placement, were 7.5 ± 2.3 and 8.5 ± 1.1, respectively. (5) Conclusions: Based on the findings of this preliminary clinical study, HFT has led to stability of peri-implant tissues and could represent a reliable technique for surgical preparation of the implant site.

Analysis of Dental Implant Rehabilitation in the Reconstructed Jaw by Deep Circumflex Iliac Artery Flap, a Retrospective Study

The purpose of this study is to analyze the clinical results of the implant rehabilitation for a jaw reconstructed by the deep circumflex iliac artery (DCIA) flap. A total of 13 patients were included in this study from 2010 to 2020. Medical records were collected retrospectively and analyzed. The mandible was involved in 10 cases and the maxilla was in 3 cases. The average width of the DCIA flap was 8.6 mm, and the height was 20.65 mm. A total of 41 dental implants with a diameter of 3.9–5.0 mm and a length of 10.0–11.5 mm were placed at an average of 12.3 months after the reconstruction. The average follow-up period after delivering a permanent prosthesis was 15 months (range, 2 to 51 months) and the overall mean follow-up period was 48 months. In all, 3 implants of the total 41 implants were removed. The DCIA flap is the most suitable for reproducing the original contour of the original jawbone compared with the fibular flap. In addition, the height and width of the reconstructed bone is appropriate for implant placement, which is advantageous for the rehabilitation of oral function and aesthetics using the implant.

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.

Primary Implant Stability Analysis of Different Dental Implant Connections and Designs-An In Vitro Comparative Study

Primary implant stability can be evaluated at the time of placement by measuring the insertion torque (IT). However, another method to monitor implant stability over time is resonance frequency analysis (RFA). Our aim was to examine the effect of bone type, implant design, and implant length on implant primary stability as measured by IT and two RFA devices (Osstell and Penguin) in an in vitro model. Ninety-six implants were inserted by a surgical motor in an artificial bone material, resembling soft and dense bone. Two different implant designs-conical connection (CC) and internal hex (IH), with lengths of 13 and 8 mm, were compared. The results indicate that the primary stability as measured by RFA and IT is significantly increased by the quality of bone (dense bone), and implant length and design, where the influence of dense bone is similar to that of CC design. Both the Osstell and Penguin devices recorded higher primary implant stability for long implants in dense bone, favoring the CC over the IH implant design. The CC implant design may compensate for the low stability expected in soft bone, and dense bone may compensate for short implant length if required by the anatomical bone conditions.

Guided Bone Regeneration in the Edentulous Atrophic Maxilla Using Deproteinized Bovine Bone Mineral (DBBM) Combined with Platelet-Rich Fibrin (PRF)-A Prospective Study

Background: Bone regeneration procedures represent a major challenge in oral surgery. This study aimed to evaluate a composite PRF/particulate xenograft in guided bone regeneration. Methods: Edentulous patients with horizontal ridge deficiencies in the anterior maxilla and candidates to an immediate-loading full-arch rehabilitation were included. Horizontal linear measurements indicating bone gain were assessed from computer beam computer tomography (CBCT) scans obtained at pre-surgery, post-surgery, and the 12-month follow-up. Mean bone values were presented as mean ± 95% CI. Non-parametric tests were used as appropriate, and the effect size was calculated with Cohen’s d repeated measures. Results: Eighteen patients were rehabilitated with 72 implants. The mean horizontal bone width was 4.47 [4.13–4.80] mm pre-surgically, 9.25 [8.76–9.75] mm post-surgically, and 7.71 [7.28–8.14] mm 12 months after. Conclusions: PRF associated with a xenograft seems to promote an effective horizontal bone gain. Randomized clinical trials are needed to confirm the benefits of this surgical approach.

Usefulness of Magnetic Mallet in Oral Surgery and Implantology: A Systematic Review

This systematic review aimed to answer the question: “Is the use of magnetic mallet effective in oral and implant surgery procedures in terms of tissue healing, surgery outcome, and complication rate compared to traditional instruments?” A literature search of PubMed, Scopus, and Web of Science databases (articles published until 1 October 2021) was conducted, in accordance with the PRISMA statement, using the keywords “magnetic mallet”, “electric mallet”, “oral surgery”, “implantology”, and “dental implant”. Of 252 articles, 14 were included in the review (3 for teeth extraction, and 11 for implant dentistry). Out of a total of 619 dental extractions (256 patients) performed with the magnetic mallet (MM), no complications were reported. Implants inserted totaled 880 (525 patients): 640 in the MM groups (382), and 240 in control groups (133). The survival rate of implants was 98.9% in the MM groups, and 95.42% in the control groups. Seven patients experienced benign paroxysmal positional vertigo after implant surgery, all in control groups. Results are not sufficient to establish the effectiveness of MM in oral and implant surgery procedures. Randomized controlled trials with a large sample size are needed.

Reliability and Correlation of Different Devices for the Evaluation of Primary Implant Stability: An In Vitro Study

Our aim was to analyze the correlation between the IT evaluated by a surgical motor and the primary implant stability (ISQ) measured by two RFA devices, Osstell and Penguin, in an in vitro model. This study examines the effect of bone type (soft or dense), implant length (13 mm or 8 mm), and implant design (CC: conical connection; IH: internal hexagon), on this correlation. Ninety-six implants were inserted using a surgical motor (IT) into two types of synthetic foam blocks. Initial measurements for both the peak IT and ISQ were recorded at the point when implant insertion was stopped by the surgical motor, and the final measurements were recorded when the implant was completely inserted into the synthetic blocks using only the RFA devices. Our null hypothesis was that there is a good correlation between the devices, independent of the implant length, design, or bone type. We found a positive, significant correlation between the IT, and the Osstell and Penguin devices. Implant length and bone type did not affect this correlation. The correlation between the devices in the CC design was maintained; however, in the IH design it was maintained only between the RFA devices. We concluded that there is a high positive correlation between the IT and ISQ from a mechanical perspective, which was not affected by bone type or implant length but was affected by the implant design.

Human Periodontal Ligament Stem Cells Response to Titanium Implant Surface: Extracellular Matrix Deposition

The major challenge for dentistry is to provide the patient an oral rehabilitation to maintain healthy bone conditions in order to reduce the time for loading protocols. Advancement in implant surface design is necessary to favour and promote the osseointegration process. The surface features of titanium dental implant can promote a relevant influence on the morphology and differentiation ability of mesenchymal stem cells, induction of the osteoblastic genes expression and the release of extracellular matrix (ECM) components. The present study aimed at evaluating the in vitro effects of two different dental implants with titanium surfaces, TEST and CTRL, to culture the human periodontal ligament stem cells (hPDLSCs). Expression of ECM components such as Vimentin, Fibronectin, N-cadherin, Laminin, Focal Adhesion Kinase (FAK) and Integrin beta-1 (ITGB1), and the osteogenic related markers, as runt related transcription factor 2 (RUNX2) and alkaline phosphatase (ALP), were investigated. Human PDLSCs cultured on the TEST implant surface demonstrated a better cell adhesion capability as observed by Scanning Electron Microscopy (SEM) and immunofluorescence analysis. Moreover, immunofluorescence and Western blot experiments showed an over expression of Fibronectin, Laminin, N-cadherin and RUNX2 in hPDLSCs seeded on TEST implant surface. The gene expression study by RT-PCR validated the results obtained in protein assays and exhibited the expression of RUNX2, ALP, Vimentin (VIM), Fibronectin (FN1), N-cadherin (CDH2), Laminin (LAMB1), FAK and ITGB1 in hPDLSCs seeded on TEST surface compared to the CTRL dental implant surface. Understanding the mechanisms of ECM components release and its regulation are essential for developing novel strategies in tissue engineering and regenerative medicine. Our results demonstrated that the impact of treated surfaces of titanium dental implants might increase and accelerate the ECM apposition and provide the starting point to initiate the osseointegration process.

Counterclockwise Drilling with Different Tapered Drills Condenses the Implant Bed-An Optical Coherence Tomography In Vitro Study

Background and Objectives: To evaluate the condensation and the microarchitecture of implant bed walls of sites prepared with counterclockwise drilling with tapered implant drills using optical coherence tomography. Materials and Methods: Four drill designs with different wall and tip angles were used. Polyurethane laminas resembling type IV bone microarchitecture were superimposed and clamped with a vice to simulate the coronal, middle, and apical aspects of the implant site. Twenty implant beds were prepared at 1200 rpm in clockwise (control) and counterclockwise (test) directions (N = 160). Optical coherence tomography (OCT) was used to evaluate the condensation and microarchitecture characteristics of the implant bed walls. The relative condensation was calculated using the Image J software Bone application. The microarchitecture was evaluated in reconstructed 3D volumes in XY, XZ, and YZ sections. Statistical analysis was performed using one-way ANOVA. Dunnet test was applied to determine differences between groups. Significance was set as p < 0.05. Results: Counterclockwise drilling (Test) condensed and changed the microarchitecture of the apical regions for all the implant beds in all of the groups when compared to clockwise drilling (control). The apical region of test groups showed the highest relative bone condensation (p = 0.026) when compared to controls. Conclusions: The direction of rotation (counterclockwise drilling) and not the design of tapered drills (tip and wall angles) is responsible for the condensation at the apical area observed in polyurethane blocks. The OCT method can be used for the evaluation of changes in density and microstructure of polyurethane blocks.

An In Vitro Analysis on Polyurethane Foam Blocks of the Insertion Torque (IT) Values, Removal Torque Values (RTVs), and Resonance Frequency Analysis (RFA) Values in Tapered and Cylindrical Implants

Background: Several different dental implant microgeometries have been investigated in the literature for use in low-density bone sites. The polyurethane solid rigid blocks represent an optimal in vitro study model for dental implants, because their composition is characterized by symmetrical linear chains of monomers of hexa-methylene sequences producing a self-polymerization process. The aim of the present investigation was to evaluate the primary stability of cylindrical and tapered implants positioned into low-density polyurethane solid rigid blocks. Materials and Methods: Two different macrogeometries, cylindrical (4 mm diameter and 10 mm length) and tapered dental implants (4.20 mm diameter and 10 mm length), were investigated in the present study. The implants were inserted into 10 PCF and 20 PCF polyurethane blocks, with and without an additional cortical layer. The insertion torque (IT) values, the removal torque values (RTVs), and the resonance frequency analysis (RFA) values were measured and recorded. Results: A total of 80 sites were tested, and a significant increased primary stability (PS) was detected in favour of tapered dental implants when compared to cylindrical implants in all experimental conditions (p < 0.05). Higher IT, RT, and RFA values were measured in tapered implants in 10 and 20 PCF polyurethane blocks, both with and without the additional cortical layer. Conclusions: Both implants showed sufficient primary stability in poor density substrates, while, on the other hand, the tapered microgeometry showed characteristics that could also lead to clinical application in low-density posterior maxillary sites, even with a drastically decreased bone cortical component.

Effect of Platelet Concentrates on Marginal Bone Loss of Immediate Implant Procedures: A Systematic Review and Meta-Analysis

BACKGROUND

To evaluate marginal bone loss (MBL) in immediate implant procedures (IIP) placed in conjunction with platelet concentrates (PCs) compared to IIP without PCs.

METHODS

A search was performed in four databases. Clinical trials evaluating MBL of IIP placed with and without PCs were included. The random effects model was conducted for meta-analysis.

RESULTS

Eight clinical trials that evaluated MBL in millimeters were included. A total of 148 patients and 232 immediate implants were evaluated. The meta-analysis showed a statistically significant reduction on MBL of IIP placed with PCs when compared to the non-PCs group at 6 months (p < 0.00001) and 12 months (p < 0.00001) follow-ups. No statistically significant differences were observed on MBL of IIP when compared PCs + bone graft group vs. only bone grafting at 6 months (p = 0.51), and a significant higher MBL of IIP placed with PCs + bone graft when compared to only bone grafting at 12 months was found (p = 0.03).

CONCLUSIONS

MBL of IIP at 6 and 12 months follow-ups is lower when PCs are applied in comparison to not placing PCs, which may lead to more predictable implant treatments in the medium term. However, MBL seems not to diminish when PCs + bone graft are applied when compared to only bone grafting.

Thermal Evaluation by Infrared Thermography Measurement of Osteotomies Performed with Er:YAG Laser, Piezosurgery and Surgical Drill-An Animal Study

The bone healing process following osteotomy may vary according to the type of surgical instrumentation. The aim of the present in vivo study was to determine thermal changes of the bone tissue following osteotomies performed by Er:YAG laser ablation in contact and non-contact modes, piezoelectric surgery, and surgical drill using an infrared thermographic camera. For each measurement, the temperature before the osteotomy-baseline (Tbase) and the maximal temperature measured during osteotomy (Tmax) were determined. Mean temperature (ΔT) values were calculated for each osteotomy technique. The significance of the difference of the registered temperature between groups was assessed by the ANOVA test for repeated measures. Mean baseline temperature (Tbase) was 27.9 ± 0.3 °C for contact Er:YAG laser, 29.9 ± 0.3 °C for non-contact Er:YAG laser, 29.4 ± 0.3 °C for piezosurgery, and 28.3 ± 0.3 °C for surgical drill. Mean maximum temperature (Tmax) was 29.9 ± 0.5 °C (ΔT = 1.9 ± 0.3 °C) for contact Er:YAG laser, 79.1 ± 4.6 °C (ΔT = 49.1 ± 4.4 °C) for non-contact Er:YAG laser, 29.1 ± 0.2 °C (ΔT = −0.2 ± 0.3 °C) for piezosurgery, and 27.3 ± 0.4 °C (ΔT = −0.9 ± 0.4 °C) for surgical drill. Statistically significant temperature changes were observed for the non-contact laser. The results of the study showed beneficial effects of the osteotomy performed by the Er:YAG laser used in the contact mode of working as well as for piezosurgery, reducing the potential overheating of the bone tissue as determined by means of infrared thermography.

In Vitro Assessment of the Effect of Implant Position on Biomechanical Behaviors of Implant-Supported Removable Partial Dentures in Kennedy Class II Condition

The purpose of this study was to investigate the effects of implant position and loading position on biomechanical behaviors using implant-supported removable partial denture (ISRPD) models in a simulated Kennedy class Ⅱ partially edentulous mandible. Three types of Kennedy class Ⅱ mandibular acrylic resin models (a conventional RPD without support by an implant—CRPD; models with an implant placed at first molar (#46)—MP-ISRPD— and second molar (#47)—DP-ISRPD) were used to measure vertical displacement of the RPD, mesio-distal displacement of the abutment tooth, and bending moment of the abutment tooth and implant under one-point loading. The variables at three respective loading points (#45, #46 and #47) were compared statistically. Vertical displacement was suppressed in ISRPDs compared to the CRPD, and significant effects were identified under loading at the implant position. The largest meiso-distal displacement was observed in MP-ISRPD under #47 loading. Bending moments of the abutment tooth and implant were significantly higher in MP-ISRPD than in DP-ISPRD. In MP-ISRPD, a higher bending moment of the abutment tooth under #45 and #47 loading was detected, although the bending moment in DP-ISRPD was almost zero. The results of this study suggested that MP-ISRPD shows the specific biomechanical behaviors, although DP-ISRPD might provide biomechanical benefits under all one-point loading conditions.

Flapless Cone Beam Computed Tomography-Guided Implant Surgery with Contextual Transcrestal Sinus Lift Augmentation Using New Bone Compactor Tools

In the present paper, the authors present a case report of premolar edentulism in the upper jaw treated through a guided flapless oral implant surgery with contextual crestal sinus lift, performed with a system of manual screw-tapered bone expanders (B&B Dental, San Benedetto, BO, Italy). The surgery was planned by means of dedicated software, through which the data obtained from the CBCT and from intraoral scanner impression were matched, with consequent production of a surgical template. The proposed surgical procedure is minimally invasive, very simple, and fast and ensures good comfort for the patient by avoiding the elevation of mucoperiosteal flaps and uncomfortable malleting maneuvers. In addition, the presented method shows a good degree of correspondence between the ideal position of the implant in the planning phase and the actual one detectable after the surgery.

Can Bone Compaction Improve Primary Implant Stability? An In Vitro Comparative Study with Osseodensification Technique

Background: This study aims to analyze bone compaction and osseodensification techniques and to investigate how cancellous bone compaction could influence primary implant stability (PS). Methods: Two different surgical protocols (bone compactors—BC; osseodensification drills—OD) were compared by placing 20 implants into 20 fresh pig ribs for each procedure. Peak insertion torque (PIT) and peak removal torque (PRT) were investigated using an MGT-12 digital torque gauge, and implant stability quotient (ISQ) was analyzed using an Osstell® Beacon device. Results: Analysis of our data (T-test p < 0.05) evidenced no statistically significant difference between BC and OD in terms of PIT (p = 0.33) or ISQ (p = 0.97). The comparison of PRT values showed a statistically significant difference between BC and OD protocols (p = 0.009). Conclusions: Cancellous bone compaction seems to improve PS, preserving a significant amount of bone and evenly spreading trabeculae on the entire implant site. While the PIT and ISQ values obtained are similar, the PRT values suggest different physical responses from the surrounding bone tissue. Nevertheless, a larger sample and further in vivo studies are necessary to validate the usefulness of BC protocol in several clinical settings.