The Effect of Osteotomy Preparation Technique and Implant Diameter on Primary Stability and Bone-implant Interface of Short Implants (6 mm).

PURPOSE: To evaluate the effect of osteotomy preparation technique and implant diameter on primary stability and bone-implant interface of short implants (6mm), when placed in bone with high degree of cancellous content. MATERIAL AND METHOD: 90 short (S) implants (6 mm) divided in nine groups based on width (Narrow 4.2 mm, Regular 4.8 mm, Wide 5.4 mm) (N,R,W) and osteotomy preparation (Standard, Osteotome, Osseodensification) (ST, OT, OD) and placed in porcine tibia plateau bone samples: Group SN-ST; Group SN-OT; Group SN-OD; Group SRST; Group SR-OT; Group SR-OD; Group SW-ST; Group SW-OT and Group SW-OD. Insertion torque and Implant Stability Quotient (ISQ) were measured. Four implants from each group SNST, SN-OT, SN-OD were evaluated histomorphometrically. RESULTS: Insertion torque was significantly higher for implants of Group SW-OD compared to Group SW-ST (50.00 ±14.14 Ncm vs 28.00 ±10.85 Ncm, p= 0.005) and Group SW-OT compared to Group SW-ST (46.87 ±17.10 Ncm vs 28.00 ±10.85 Ncm, p=0.026). Insertion torque was significantly higher for implants of Group SW-OD compared to Group SN-OD (50.00 ±14.14 Ncm vs 31.5 ±15.82 Ncm, p=0.04). No significant differences were observed for the percentage of bone, marrow space and connective tissue in contact to the implant surface between studied groups. CONCLUSION: Osteotomy preparation technique at sites with high degree of cancellous content can influence the implant insertion torque for short and wide implants (5.4x6mm). Implant width can influence the insertion torque of short implants placed with the osseodensification technique.

Osseodensification: An Innovative Technique With Manifold Gains.

Prosthodontics, which is removable and fixed, is the branch dealing with the replacement of missing teeth. Implant therapy is the popular treatment modality and commonly preferred treatment option by many patients and clinicians for missing teeth in recent years. Primary implant stability (PIS) is one of the crucial factors for osseointegration. It has been considered a crucial factor in the success of implants. Moreover, several factors influence PIS. On the other hand, both secondary implant stability and osseointegration are influenced by the PIS. Bone density, bone volume, bone-to-implant contact, and other factors that enhance or degrade the primary stability. Certain host sites such as the maxillary posterior region demand more dense bone to achieve desired results as they are the low-density areas of the jaw. So, a new promising and growing innovative concept of osseodensification (OD) offers a great solution with multiple benefits and desirable results. This review article aims to enlighten the multiple benefits of OD technique and their mechanism of action.

The Effectiveness of Osseodensification Drilling versus the Conventional Surgical Technique on Implant Stability: A Clinical Trial.

Background/Objective: To ensure that implants are able to support prosthetic rehabilitation, a stable and functional union between the bone and the implant surface is crucial to its stability and success. To increase bone volume and density and excel bone-implant contact, a novel drilling method, called osseodensification (OD), was performed. To assess the effectiveness of the osseodensification drilling protocol versus the conventional surgical technique on implant stability. Methods: Bone Level Tapered Straumann implants were placed side-by-side with both OD and subtractive conventional drilling (SD) in 90 patients from CESPU-Famalicão clinical unit. IT was measured using a manual torque wrench, and the Implant stability quotient (ISQ) value was registered using the Osstell® IDX. Results: According to the multifactorial ANOVA, there were statistically significant differences in the mean IT values due to the arch only (F(1.270) = 4.702, p-value = 0.031 < 0.05). Regarding the length of the implant, there were statistically significant differences in the mean IT in the OD group (p = 0.041), with significantly lower mean IT values for the Regular implants compared to the Long. With respect to the arch, the analyses of the overall ISQ values showed an upward trend in both groups in the maxilla and mandible. High levels of IT also showed high ISQ values, which represent good indicators of primary stability. Conclusions: OD does not have a negative influence on osseointegration compared to conventional subtractive osteotomy.

Maxillary Sinus Floor Elevation and Simultaneous Implant Installation via Osseodensification Drills: A Retrospective Analysis of Bone Gain in 72 Patients Followed for 6 Months.

Background/Objectives: The aim of this retrospective study was to radiographically evaluate the endo-sinus bone gain (ESBG) following osseodensification procedures using CBCT and compare the results to more conventional sinus lifting techniques. Methods: A total of 72 patients underwent crestal sinus floor elevation procedures and were provided with 102 implants with a sand-blasted and acid-etched surface with microthreads (Medentika® Microcone Implants, Hugelsheim, Germany). Patients were divided into two groups; the osseodensification group (OD; n = 36) and the osseodensified augmentation group (ODA; n = 36). Results: The mean residual bone height (RBH) was 5.71 (1.77) and 4.30 (0.94) mm in the OD and ODA groups, respectively. An ESBG of 3.45 (1.18) and 5.74 (1.31) mm was observed in the OD and ODA groups, respectively, and as compared to the baseline RBH, the ESBG was statistically significant in both groups after 6 months (p < 0.001). Conclusions: Within the limits of this retrospective study, crestal sinus lifting with the osseodensification technique seems to be a fast, effective, and safe method. Longer follow-up studies with full intrasinus bone topography and structure analyses are needed to prove the success rate of endo-sinus bone gain.

Conventional Versus Osseodensification Drilling in the Narrow Alveolar Ridge: A Prospective Randomized Controlled Trial.

Background Conventionally, undersized osteotomies were used to increase initial bone-to-implant contact to achieve primary stability in implantology. This is particularly evident in regions with low bone density. The potential for severe bone compression and ischemia poses a challenge to secondary stability. Instead, lateral bone compaction is caused by the idea of osseodensification. Research on the potential benefits of this method for narrow ridges is lacking. This study aimed to determine if the osseodensification drilling technique affects primary stability and how much the alveolar ridge expands following implant site preparation. Methodology A total of 30 participants aged 20 to 80 years were included in this randomized controlled clinical investigation. Each participant was randomly assigned to one of the following two groups: one that received standard drill preparation, and another that received osseodensification drill preparation. Implant stability using implant stability quotient values, crest width, apical width (5 mm from crest), and bone density were assessed both before and after six months using cone-beam computed tomography. Results Osseodensification impacted the width at the apex (5 mm from the crest) and radiographic bone density, adding to the quality, but did not affect implant stability and crestal width after osseointegration. The mean difference in conventional and osseodensification groups was 0.46 and 0.68 mm, respectively, concerning the crestal width. Moreover, the mean difference was 0.74 and 0.58 mm for conventional and osseodensification groups, respectively, concerning the width at the apex (5 mm from the crest). Conclusions This study demonstrates that the osseodensification process increased both the radiographic bone density and the width at the apex, demonstrating that osseodensification drilling techniques allow for the placement of implants with larger diameters in narrow alveolar ridges.

Biomechanical and histomorphometric analysis of osseodensification drilling versus conventional technique: a systematic review and meta-analysis.

OBJECTIVES: This systematic review aimed to search the literature for the answer to the following questions. In human studies: Does the osseodensification technique increase the resonance frequency analysis given in implant stability quotient value and the insertion torque value compared to the conventional technique? In animal studies: Does the osseodensification technique increase implant stability quotient, bone-to-implant contact, and bone area fraction occupancy values over the conventional technique? DATA SOURCES: A search for studies was carried out in eight databases until August 2021. Out of the 447 publications found, 11 were included. RESULTS: In human studies, osseodensification technique showed better results for implant stability quotient values with a summarized median difference of 8.57. As for secondary stability, there was no significant difference, with summarized median difference of 4.49 in favor of the osseodensification technique. In animal studies, all results were favorable to the osseodensification technique. Regarding insertion torque, bone-to-implant contact, and bone area fraction occupancy between counterclockwise osseodensification technique vs conventional, the mean difference was 46.79 for insertion torque, 2.17 for bone-to-implant contact, and 2.11 for bone area fraction occupancy. High heterogeneity was observed between the studies. The risk of bias in humans was moderate in three studies and low in one; and in animal studies, four presented moderate risk, two low risk, and one high risk. The certainty of evidence ranged from low to moderate. CONCLUSION: The osseodensification technique showed improvement concerning the resonance frequency and the insertion torque value of implants in human studies. In addition, it increased the values of bone-to-implant contact, bone area fraction occupancy, and implant stability quotient in animal studies, when compared to the conventional technique.

Osseodensification versus lateral window technique for sinus floor elevation with simultaneous implant placement: A randomized clinical trial on patient-reported outcome measures.

OBJECTIVES: To compare patient-reported outcome measures and additional surgical outcomes after sinus floor elevation (SFE) with osseodensification (OD) versus lateral window (LW), both with simultaneous implant placement. MATERIALS AND METHODS: Twenty participants requiring single-implant rehabilitation with residual bone height (RBH) ≤4 mm were enrolled. Pain experience, quality of life (QoL) via the Oral Health Impact Profile-14 (OHIP-14), analgesics intake, and other symptoms were self-reported for a week on a daily basis. Surgery duration, complications, and implant stability quotient at baseline (ISQ T0 ) and after 6 months (ISQ T6 ) were registered. Participants were followed up for 1 year. RESULTS: From Day 0 (day of surgery) to Day 3, pain experience was significantly lower (p < 0.05) in the OD group. OHIP-14 score was significantly lower (p < 0.05) in the OD group on all postoperative days, except on Day 5. Average analgesics intake was significantly lower (p < 0.001) in the OD group. Surgery mean duration was significantly higher (p < 0.001) in LW compared to OD (71.1 ± 10.4 vs. 32.9 ± 5.3 min). After osseointegration period, all implants were successfully restored with screw-retained crowns. CONCLUSIONS: Within the limitations of this study, it can be concluded that OD and LW techniques were similarly effective in SFE with simultaneous implant placement when RBH ≤ 4 mm. However, OD significantly outperformed LW in pain experience, impact on self-perceived QoL, surgery duration, postoperative edema, and analgesics intake.

A Comparative Assessment of Primary Implant Stability Using Osseodensification vs. Conventional Drilling Methods: A Systematic Review.

Osseodensification is a novel biomechanical bone preparation technique that has been established to replace conventional bone drilling and therefore will optimize the implant site. The purpose of this systematic review was to compare the implant stability obtained by osseodensification drilling to those associated with conventional drilling techniques. An electronic search was performed in the PubMed, Scopus, EMBASE, Cochrane Oral Health Group, and Dentistry and Oral Science Source databases searched through Elton B. Stephens Company (EBSCO) for potentially relevant publications in the English language from January 2013 to December 2022. Randomized clinical trials (RCTs) and non-randomized studies of interventions (NRSIs), contrasting osseodensification drilling with conventional drilling, studies documenting implant stability quotient (ISQ), and studies reporting the immediate outcome and at least three months of follow-up after dental implant placement were included. Two independent investigators evaluated the quality of the reviewed studies to determine the risk of bias using the version 2 of Cochrane risk-of-bias (RoB) tool for RCTs (RoB 2) and RoB for NRSIs (ROBINS-I). Majority of the studies showed that bone density was significantly higher in the osseodensification group. The overall RoB for the NRSIs was reported to be low with respect to confounding, selection, classification, incomplete data, deviance from interventions, outcome evaluation, and selective reporting. The quality assessment of the RCT studies included in the review using the RoB 2 tool showed a high overall risk. The findings of the current review reveal that osseodensification drilling exhibited higher resonance frequency analysis (RFA) and ISQ values than conventional drilling protocols. Similarly, when osseodensification regions were contrasted with traditional drilling, bone density at the implant surface was augmented.

Evaluation of crestal sinus floor elevation in cases exhibiting an oblique sinus floor with a residual bone height of 4.0-7.0 mm using Densah burs with simultaneous implant placement: a prospective clinical study.

PURPOSE: To evaluate the effectiveness of using Densah burs for lifting the maxillary sinus membrane in cases with an oblique sinus floor with a residual bone height of 4-7 mm. METHODS: The study was conducted on 16 patients, comprising 9 males and 7 females, aged 25-60 years, split into two groups of 8 each: group I with a residual bone height of 4-5.5 mm below the sinus floor and group II with a residual bone height of 5.5-7 mm. Exclusion criteria included smokers, presence of systemic or metabolic conditions that contraindicate implant placement and a local sinus pathology. The study involved the use of Densah burs, using the osseodensification concept to elevate the sinus floor, along with simultaneous dental implant placement. The integrity of the sinus membrane was verified via clinical examination and a confirmatory cone beam computed tomography scan. RESULTS: The study revealed that out of the 16 cases, one case had a sinus membrane perforation, confirmed clinically at the time of the operation. The study achieved a mean lift of 4.42 mm and a mean final seating torque of 35.5 N/cm. At the 1-year follow-up, all cases showed clinical success, with no signs of sinus pathology or complications. CONCLUSIONS: In cases with oblique sinus floors and a residual bone height of 4-7 mm in moderately atrophic posterior maxilla, the osseodensification concept proved to be a safe and effective method for performing sinus lift procedures with simultaneous implantation.

Osseodensification: An Alternative to Conventional Osteotomy in Implant Site Preparation: A Systematic Review.

Osseodensification is an innovative method of preparing the implant osteotomy using drills that promote bone self-compaction. The main objective of this technique is to promote peri-implant bone densification and compaction of autologous bone and to increase the primary stability of the implant due to the viscoelastic characteristics of the alveolar bone using Densah® burs in a counterclockwise direction at a speed of 800 to 1500 rpm. The objective of this review is the analysis of the scientific literature regarding the applicability of the osseodensification technique in oral implantology. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were used and registered at PROSPERO. The search strategy included electronic databases from 2016 to 2023 and was performed by two independent reviewers. The results demonstrate the advantage of the osseodensification technique in relation to conventional drilling, allowing an increase in the bone density and primary stability of the implant, bone density, and bone-implant contact. The osseodensification technique can be applied in different clinical situations: sub-antral bone grafts, narrow alveolar bone crests, low-density bone areas, and immediate implant placement in post-extraction sockets.

Instalação de implante em região posterior de maxila através da técnica de Summers e osseodensificação: relato de caso / Implant installation in posterior maxilla using the Summers technique and osseodensification: a case report / Instalación de implantes en la región posterior del maxilar utilizando la técnica de Summers y la oseodensificación: informe de un caso

Este trabalho tem por objetivo relatar um caso em que foi realizada a técnica de Summers para elevação do seio maxilar, associada à realização de osseodensificação. Paciente do gênero masculino, 53 anos, apresentando ausência do dente 17, com altura reduzida na área edêntula. Foi realizada a elevação do seio maxilar pela técnica de Summers associada à osseodensificação da região para uma melhora da qualidade óssea. Foi instalado um implante cone morse SIN de 3.8 x 8.5 com torque de 45 newtons. No acompanhamento pós-operatório não houve qualquer sinal ou sintoma de complicação e o paciente foi reabilitada com uma prótese parafusada sobre implante.

This study aims to report a case in which the Summers technique was performed for maxillary sinus elevation, associated with osseodensification. Male patient, 53 years old, with missing tooth 17, with reduced height in the edentulous area. Maxillary sinus elevation was performed using the Summers technique associated with osseodensification of the region for an improvement in bone quality. A 3.8 x 8.5 SIN morse taper implant with a torque of 45 newtons was installed. In the postoperative follow-up, there were no signs or symptoms of complications and the patient was rehabilitated with a screw-retained implant prosthesis.

Este trabajo tiene como objetivo informar de un caso en el que se realizó la técnica de Summers para la elevación del seno maxilar, asociada a la osteodensificación. Paciente varón, de 53 años, que presenta ausencia del diente 17, con altura reducida en la zona edéntula. Se elevó el seno maxilar mediante la técnica de Summers asociada a la osteodensificación de la región para mejorar la calidad ósea. Se instaló un implante morse cónico de 3,8 x 8,5 SIN con un par de 45 newtons. En el seguimiento postoperatorio no hubo signos ni síntomas de complicación y el paciente fue rehabilitado con una prótesis atornillada sobre un implante.

Autonomous Dental Implant Robotic System Utilization for Implant Placement and Transcrestal Sinus Elevation Using Osseodensification: A Case Report.

Robotic systems have revolutionized various industries, and dentistry is no exception. Recently, due to the robust advancements in artificial intelligence and technology, there has been a significant evolution of dental robotic systems, ranging from surgeon controlled, robot-assisted operations, to more autonomous processes. The present clinical case report describes a 1-year follow-up of the successful use of an autonomous dental implant robot system with an osseodensification (OD) protocol for implant osteotomy preparation, maxillary sinus elevation, and simultaneous implant placement at the maxillary second premolar site. A prefabricated provisional prosthesis was delivered immediately after implant placement, with final prosthesis delivery at 3 months. The findings from this report demonstrate the integration and clinical augmentation of more autonomous protocols in the field of implant dentistry using dental robots.

Immediate dental implantation after indirect sinus elevation using osseodensification concept: a case report.

Implantation in the posterior maxilla is more challenging due to the insufficient bone height after maxillary sinus pneumatization and the low bone density. Osseodensification (OD) is considered a novel, less invasive, and more effective indirect sinus floor elevation technique. Case presentation: A 52-year-old male presented to the oral and maxillofacial surgery department with a main complaint of chewing difficulties in the right posterior area maxilla (teeth numbers: 26 and 27). A cone-beam computed tomography (CBCT) imaging showed that the residual bone height ranged between 1 and 4 mm and the width ranged between 9 and 12 mm in the area of teeth numbers 16 and 17. Intervention and outcome: The treatment plan was to extract the teeth (numbers: 16 and 17) and conduct internal sinus lifting and bone grafting using the OD burs with immediate implantation. Clinical discussion: OD is proposed as an alternative procedure to the direct (lateral window) sinus floor elevation procedure. The amount of vertical bone gain obtained by this technique in transcrestal sinus lifting can be the same as external sinus lifting in this case. Conclusion: OD can be considered a promising technique for direct sinus floor elevation, considering the amount of vertical bone gain obtained by this technique.

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.

Evaluación de Cambios Dimensionales en Ancho y Altura del Reborde Óseo Alveolar Mediante la Técnica de Oseodensificación en Zonas Posteriores del Maxilar. Reporte de Serie de Casos

Con el objetivo de tratar mediante implantes dentales zonas de tejido óseo incipiente y minimizar el uso de técnicas más invasivas, surge la oseodensificación (OD), una técnica realizada mediante la utilización de fresas Densah®, diseñadas para aumentar la densidad ósea, desplazando y condensando el tejido óseo circundante al fresado. El objetivo del estudio fue determinar los cambios dimensionales en ancho y altura del reborde óseo alveolar (ROA) en zonas posteriores del maxilar utilizando la técnica de OD, 3 meses posterior a realizada la cirugía. Se realizaron evaluaciones imagenológicas mediante Cone-Beam-CT (preoperatorio y mínimo 3 meses postoperatorio) a 9 pacientes, en los que se instalaron 10 implantes, divididos según instalación mediata e inmediata. En ambos grupos, se midió el ancho del ROA tanto a nivel marginal, utilizando como referencia el plano de la cresta ósea vestibular (COV), como 4 mm apical al plano COV. También se midió la altura del ROA con relación al plano COV y al piso del seno maxilar (PSM). Las comparaciones se realizaron mediante el análisis estadístico prueba t student-muestras pareadas. Los datos imagenológicos mostraron un valor de p<0,05 para la expansión ósea, tanto en ancho (solo implantes mediatos, media 2,11 ± 1,66 mm) como en altura con relación a PSM (implantes mediatos e inmediatos, medias de 2,28 ± 2,21 y 1,88 ± 1,82 respectivamente). La técnica de OD resultó ser efectiva en generar un aumento, tanto en ancho de implantes mediatos a nivel del plano COV como en altura del ROA en implantes mediatos e inmediatos.

In order to treat areas of incipient bone tissue with dental implants and minimize the use of more invasive techniques, osseodensification (OD) is a technique performed using Densah® drills, designed to increase bone density by displacing and condensing the bone tissue surrounding the drill. To determine the dimensional changes in width and height of the alveolar bone ridge (ABR) in posterior regions of the maxilla using the OD technique, 3 months after surgery. Imaging evaluations were performed by Cone- Beam-CT (preoperative and at least 3 months postoperative) in 9 patients, in whom 10 implants were installed, divided according to mediate and immediate installation. In both groups, the width of the ABR was measured both at the marginal level, using the vestibular osseous ridge plane (VOR) as a reference, and 4 mm apical to the VOR plane. The height of the ROA was also measuredin relation to the VOR plane and the maxillary sinus floor (MSF). Comparisons were performed by student t-test paired-samples statistical analysis. Imaging data showed a value of p<0.05 for bone expansion, both in width (mediated implants only, mean 2.11±1.66 mm) and height in relation to PSM (mediated and immediate implants, means of 2.28±2.21 and 1.88±1.82 respectively). The OD technique proved to be effective in generating an increase in width of dental implants mediated at the level of the VOR plane and in height of the ABR (mediated and immediate implants).

The Effect of Osseodensification on Ridge Expansion, Intraosseous Temperature, and Primary Implant Stability: A Pilot Study on Bovine Ribs.

Osseodensification is a novel technique based on nonsubtractive drilling to preserve and condense bone during osteotomy preparation. The aim of this ex vivo study was to compare osseodensification and conventional extraction drilling technique with regard to intraosseous temperatures, expansion of alveolar ridge width, and primary implant stability using different implant geometries: tapered and straight walled. A total of 45 implant sites were prepared in bovine ribs following osseodensification and conventional protocols. Changes in intraosseous temperatures were recorded at 3 depths using thermocouples, and ridge width was measured at 2 different depths before and after osseodensification preparations. The primary implant stability was measured using peak insertion torque and the implant stability quotient (ISQ) following placement of straight and tapered implants. A significant change in temperature was recorded during site preparation for all techniques tested but not at all depths. Osseodensification recorded higher mean temperatures (42.7°C) than conventional drilling, particularly at the midroot level. Statistically significant ridge expansion was observed at both the crestal and apical levels in the osseodensification group. The ISQ values were significantly higher only for tapered implants placed in osseodensification sites when compared with conventional drilling sites; however, there was no difference in the primary stability between tapered and straight implants within the osseodensification group. Within the limitations of the present pilot study, osseodensification was found to increase the primary stability of straight-walled implants without overheating the bone and significantly expanded the ridge width. However, further investigation is required to determine the clinical significance of the bone expansion created by this new technique.

Comparison of insertion torque, implant stability quotient and removal torque, in two different implant designs with and without osseodensification. - An ex vivo bench top study.

Background: Primary stability is an important factor in influencing the outcome of dental implants. Osteotomy modification techniques mentioned, include osteotomes for bone condensation, under-preparation of osteotomy and Osseodensification (OD). The objective of our twin arm study was to assess how two different implant designs respond to conventional osteotomy drilling and how these values obtained compare with OD. Materials and methods: The study comprised a total of 80 implants inserted in pig tibia bone. Group 1a (n = 20) consisted of tapered internal implants and group 1b (n = 20) consisted of tapered pro implants, both inserted with conventional drilling. Group 2a (n = 20) consisted of tapered internal implants and group 2b (n = 20) consisted of tapered pro implants, both inserted with OD. Each implant inserted was measured for implant stability quotient (ISQ), insertion torque and removal torque. Results: Group 1a showed a significantly lower ISQ, mean insertion and removal torque and as compared to Group 1b. Group 2a and 2b had comparable mean values for all the three parameters. Inter-group comparison showed a higher ISQ and insertion torque value for group 2 than group 1. Intra-group assessment showed a significantly lower value for all parameters for sub-group a than b. Conclusions: OD enhances primary stability of implants in bone; but when no OD is used, the tapered pro implant design offers a better primary stability. This may be attributed to the active thread design.

Evaluation of crestal sinus floor elevations using versah burs with simultaneous implant placement, at residual bone height ≥ 2.0 _ < 6.0 mm. A prospective clinical study.

PURPOSE: To evaluate the efficacy of Versah drills in breaching the maxillary sinus floor while keeping the membrane intact, as well as measure the implant stability (primary stability at the time of implant placement by the osseous densification of the residual bone height (RBH) of ≥ 2.0 _ < 6.0 mm, and secondary stability after 6 months of osseous healing period). METHODS: This prospective clinical study, which included twenty crestal sinus floor elevations, was conducted on 17 patients (10 males and 7 females, ages 29 to 70 years). The sinus membrane integrity was clinically checked at the time of osseodensification sinus lifting and confirmed by CBCT after sinus augmentation and implant insertion. Time of operation has been recorded from the first drill to implant installation. Primary implant stability was measured using an Osstell beacon at the time of implant placement, and secondary stability was measured after 6 months of osseous healing. RESULTS: The mean of secondary stability in the current study is significantly higher than the mean of primary stability (P ≤ 0.011), which was 74.22 ± 8.11 and 69.85 ± 9.74, respectively, in RBH 3.81 mm as a mean. There was no clinical evidence of membrane perforation or complication reports, and the average operation time was 11.2 ± 1.85 min. CONCLUSION: The current study found that at highly atrophic posterior maxilla with a residual bone height of ≥ 2.0 _ < 6.0 mm, osseodensification using Versah drills was effective in crestal sinus elevation with no membrane perforation, which was confirmed by cone-beam CT scan postoperatively, and showed higher primary and secondary implant stability.

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.

Changes in implant stability using different site preparation techniques: Osseodensification drills versus piezoelectric surgery. A multi-center prospective randomized controlled clinical trial.

INTRODUCTION: Implant stability is influenced by bone density, implant design, and site preparation characteristics. Piezoelectric implant site preparation (PISP) has been demonstrated to improve secondary stability compared with conventional drilling techniques. Osseodensification drills (OD) have been recently introduced to enhance both bone density and implant secondary stability. The objective of the present multi-center prospective randomized controlled trial was to monitor implant stability changes over the first 90 days of healing after implant bed preparation with OD or PISP. METHODS: Each patient received two identical, adjacent or contralateral implants in the posterior maxilla. Following randomization, test sites were prepared with OD and control sites with PISP. Resonance frequency analysis was performed immediately after implant placement and after 7, 14, 21, 28, 60, and 90 days. Implants were then restored with single screw-retained metal-ceramic crowns and followed for 12 months after loading. RESULTS: Twenty-seven patients (15 males and 12 females; mean age 63.0 ± 11.8 years) were included in final analysis. Each patient received two identical implants in the posterior maxilla (total = 54 implants). After 1 year of loading, 53 implants were satisfactorily in function (one failure in test group 28 days after placement). Mean peak insertion torque (40.7 ± 12.3 Ncm and 39.5 ± 10.2 Ncm in test and control group, respectively) and mean implant stability quotient (ISQ) value at baseline (71.3 ± 6.9 and 69.3 ± 7.6 in test and control group, respectively) showed no significant differences between the two groups. After an initial slight stability decrease, a shift to increasing ISQ values occurred after 14 days in control group and after 21 days in test group, but with no significant differences in ISQ values between the two groups during the first 90 days of healing. CONCLUSION: No significant differences in either primary or secondary stability or implant survival rate after 1 year of loading were demonstrated between implants inserted into sites prepared with OD and PISP.