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Stoilov M, Shafaghi R, Stark H, Marder M, Kraus D, Enkling N. Influence of Implant Macro-Design, -Length, and -Diameter on Primary Implant Stability Depending on Different Bone Qualities Using Standard Drilling Protocols-An In Vitro Analysis. J Funct Biomater 2023; 14:469. [PMID: 37754883 PMCID: PMC10531925 DOI: 10.3390/jfb14090469] [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: 08/15/2023] [Revised: 09/08/2023] [Accepted: 09/10/2023] [Indexed: 09/28/2023] Open
Abstract
(1) Background: Primary implant stability is vital for successful implant therapy. This study explores the influence of implant shape, length, and diameter on primary stability in different bone qualities. (2) Methods: Three implant systems (two parallel-walled and one tapered) with various lengths and diameters were inserted into polyurethane foam blocks of different densities (35, 25, 15, and 10 PCF) using standard drilling protocols. Primary stability was assessed through insertion torque (IT) and resonance frequency analysis (RFA). Optimal ranges were defined for IT (25 to 50 Ncm) and RFA (ISQ 60 to 80). A comparison of implant groups was conducted to determine adherence to the optimal ranges. (3) Results: Implant macro-design, -length, and -diameter and bone block density significantly influenced IT and RFA. Optimal IT was observed in 8/40 and 9/40 groups for the parallel-walled implants, while the tapered implant achieved optimal IT in 13/40 groups (within a 25-50 Ncm range). Implant diameter strongly impacted primary stability, with sufficient stability achieved in only one-third of cases despite the tapered implant's superiority. (4) Conclusions: The findings highlight the need to adapt the drilling protocol based on diverse bone qualities in clinical practice. Further investigations should explore the impact of these adapted protocols on implant outcomes.
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Affiliation(s)
- Milan Stoilov
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (M.S.); (H.S.); (M.M.)
| | - Ramin Shafaghi
- Department of Reconstructive Dentistry and Gerodontology, Bern University, 3012 Bern, Switzerland;
| | - Helmut Stark
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (M.S.); (H.S.); (M.M.)
| | - Michael Marder
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (M.S.); (H.S.); (M.M.)
| | - Dominik Kraus
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (M.S.); (H.S.); (M.M.)
| | - Norbert Enkling
- Department of Prosthodontics, Preclinical Education and Dental Materials Science, Bonn University, 53111 Bonn, Germany; (M.S.); (H.S.); (M.M.)
- Department of Reconstructive Dentistry and Gerodontology, Bern University, 3012 Bern, Switzerland;
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Heimes D, Becker P, Pabst A, Smeets R, Kraus A, Hartmann A, Sagheb K, Kämmerer PW. How does dental implant macrogeometry affect primary implant stability? A narrative review. Int J Implant Dent 2023; 9:20. [PMID: 37405709 DOI: 10.1186/s40729-023-00485-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2023] [Accepted: 06/21/2023] [Indexed: 07/06/2023] Open
Abstract
PURPOSE The macrogeometry of a dental implant plays a decisive role in its primary stability. A larger diameter, a conical shape, and a roughened surface increase the contact area of the implant with the surrounding bone and thus improve primary stability. This is considered the basis for successful implant osseointegration that different factors, such as implant design, can influence. This narrative review aims to critically review macro-geometric features affecting the primary stability of dental implants. METHODS For this review, a comprehensive literature search and review of relevant studies was conducted based on formulating a research question, searching the literature using keywords and electronic databases such as PubMed, Embase, and Cochrane Library to search for relevant studies. These studies were screened and selected, the study quality was assessed, data were extracted, the results were summarized, and conclusions were drawn. RESULTS The macrogeometry of a dental implant includes its surface characteristics, size, and shape, all of which play a critical role in its primary stability. At the time of placement, the initial stability of an implant is determined by its contact area with the surrounding bone. Larger diameter and a conical shape of an implant result in a larger contact area and better primary stability. But the linear relationship between implant length and primary stability ends at 12 mm. CONCLUSIONS Several factors must be considered when choosing the ideal implant geometry, including local factors such as the condition of the bone and soft tissues at the implant site and systemic and patient-specific factors such as osteoporosis, diabetes, or autoimmune diseases. These factors can affect the success of the implant procedure and the long-term stability of an implant. By considering these factors, the surgeon can ensure the greatest possible therapeutic success and minimize the risk of implant failure.
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Affiliation(s)
- Diana Heimes
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany.
| | - Philipp Becker
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstraße 170, 56072, Koblenz, Germany
| | - Andreas Pabst
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstraße 170, 56072, Koblenz, Germany
| | - Ralf Smeets
- Department of Oral and Maxillofacial Surgery, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246, Hamburg, Germany
- Department of Oral and Maxillofacial Surgery, Division of "Regenerative Orofacial Medicine", University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Annika Kraus
- Department of Prosthetic Dentistry, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Amely Hartmann
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
- Private Practice for Oral Surgery, Echterdinger Straße 7, 70794, Filderstadt, Germany
| | - Keyvan Sagheb
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
| | - Peer W Kämmerer
- Department of Oral and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131, Mainz, Germany
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Pabst A, Asran A, Lüers S, Laub M, Holfeld C, Palarie V, Thiem DGE, Becker P, Hartmann A, Heimes D, Al-Nawas B, Kämmerer PW. Osseointegration of a New, Ultrahydrophilic and Nanostructured Dental Implant Surface: A Comparative In Vivo Study. Biomedicines 2022; 10:943. [PMID: 35625680 PMCID: PMC9138320 DOI: 10.3390/biomedicines10050943] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Revised: 03/26/2022] [Accepted: 03/28/2022] [Indexed: 02/01/2023] Open
Abstract
This study compared the osseointegration of acid-etched, ultrahydrophilic, micro- and nanostructured implant surfaces (ANU) with non-ultra-hydrophilic, microstructured (SA) and non-ultrahydrophilic, micro- and nanostructured implant surfaces (AN) in vivo. Fifty-four implants (n = 18 per group) were bilaterally inserted into the proximal tibia of New Zealand rabbits (n = 27). After 1, 2, and 4 weeks, bone-implant contact (BIC, %) in the cortical (cBIC) and spongious bone (sBIC), bone chamber ingrowth (BChI, %), and the supra-crestal, subperiosteal amount of newly formed bone, called percentage of linear bone fill (PLF, %), were analyzed. After one week, cBIC was significantly higher for AN and ANU when compared to SA (p = 0.01 and p = 0.005). PLF was significantly increased for ANU when compared to AN and SA (p = 0.022 and p = 0.025). After 2 weeks, cBIC was significantly higher in SA when compared to AN (p = 0.039) and after 4 weeks, no significant differences in any of the measured parameters were found anymore. Ultrahydrophilic implants initially improved osseointegration when compared to their non-ultrahydrophilic counterparts. In accordance, ultrahydrophilic implants might be appropriate in cases with a necessity for an accelerated and improved osseointegration, such as in critical size alveolar defects or an affected bone turnover.
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Affiliation(s)
- Andreas Pabst
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072 Koblenz, Germany; (A.P.); (P.B.)
- Department of Oral and Maxillofacial Surgery—Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (C.H.); (D.G.E.T.); (A.H.); (D.H.); (B.A.-N.)
| | - Ashraf Asran
- Morphoplant GmbH, Universitätsstr. 136, 44799 Bochum, Germany; (A.A.); (S.L.); (M.L.)
| | - Steffen Lüers
- Morphoplant GmbH, Universitätsstr. 136, 44799 Bochum, Germany; (A.A.); (S.L.); (M.L.)
| | - Markus Laub
- Morphoplant GmbH, Universitätsstr. 136, 44799 Bochum, Germany; (A.A.); (S.L.); (M.L.)
| | - Christopher Holfeld
- Department of Oral and Maxillofacial Surgery—Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (C.H.); (D.G.E.T.); (A.H.); (D.H.); (B.A.-N.)
| | - Victor Palarie
- Laboratory of Tissue Engineering and Cellular Culture, State University of Medicine and Pharmaceutics “Nicolae Testemitanu”, Stefan cel Mare si Sfant Boulevard 165, 2004 Chisinau, Moldova;
| | - Daniel G. E. Thiem
- Department of Oral and Maxillofacial Surgery—Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (C.H.); (D.G.E.T.); (A.H.); (D.H.); (B.A.-N.)
| | - Philipp Becker
- Department of Oral and Maxillofacial Surgery, Federal Armed Forces Hospital, Rübenacherstr. 170, 56072 Koblenz, Germany; (A.P.); (P.B.)
- Department of Oral and Maxillofacial Surgery—Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (C.H.); (D.G.E.T.); (A.H.); (D.H.); (B.A.-N.)
| | - Amely Hartmann
- Department of Oral and Maxillofacial Surgery—Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (C.H.); (D.G.E.T.); (A.H.); (D.H.); (B.A.-N.)
| | - Diana Heimes
- Department of Oral and Maxillofacial Surgery—Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (C.H.); (D.G.E.T.); (A.H.); (D.H.); (B.A.-N.)
| | - Bilal Al-Nawas
- Department of Oral and Maxillofacial Surgery—Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (C.H.); (D.G.E.T.); (A.H.); (D.H.); (B.A.-N.)
| | - Peer W. Kämmerer
- Department of Oral and Maxillofacial Surgery—Plastic Operations, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (C.H.); (D.G.E.T.); (A.H.); (D.H.); (B.A.-N.)
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