Citation Information :
Shafiullah RS, Hariharan R, Krishnan CS, Azhagarasan NS, JayaKrishnaKumar S, Saravanakumar M. Influence of Cortical Layer and Surgical Techniques on the Primary Implant Stability in Low-density Bone:An In Vitro Study. J Contemp Dent Pract 2021; 22 (2):146-151.
Aim: This study aimed at evaluating the influence of cortical layer and surgical techniques on the primary stability of implants in low-density bone.
Materials and methods: Two solid rigid polyurethane blocks with a density equivalent to 0.32 g/cm3 simulating cancellous bone were used. A short fiber-filled epoxy resin sheet of 2 mm was layered to one block to simulate cortico cancellous bone. A total of 40 implants were used in this study (n = 40). Twenty implants each (n = 20) were inserted in cancellous (Group 1) and cortico-cancellous bone (Group 2), of which 10 implants each (n = 10) were placed using undersized preparation technique with surgical drills—A and osteotomes—B, in both the groups. Insertion torque (IT) and implant stability quotient (ISQ) for each implant placed were assessed to determine the primary stability of each implant using a digital torque meter and resonance frequency analyzer, respectively. The values were statistically analyzed using an independent t-test (p < 0.05). Pearson's correlation analysis was performed to correlate between IT and ISQ.
Results: Technique B resulted in significantly higher IT and ISQ values in Group 1 (27.69 ± 1.2 N cm; 52.5 ± 1.05 ISQ) and Group 2 (38.8 ± 0.87 N cm; 70.1 ± 1.04 ISQ) compared to those with technique A (22.40 ± 1.62 N cm; 41.75 ± 1.20 ISQ and 33.24 ± 0.67 N cm; 63.72 ± 1.33 ISQ), respectively. Group 2 exhibited significantly higher IT and ISQ values as compared to Group 1 irrespective of the surgical technique employed (p < 0.05).
Conclusion: The presence of the cortical layer significantly influenced the primary stability and preparing low-density bone with an undersized preparation technique using osteotomes that significantly increased the IT and ISQ.
Clinical significance: Undersizing the preparation site considerably will help achieve a significant increase in primary stability in the poor quality bone as in the posterior maxilla, thereby contributing to the success of the implant.
Chong L, Khocht A, Suzuki JB, et al. Effect of implant design on initial stability of tapered implants. J Oral Implantol 2009;35(3):130–135. DOI: 10.1563/1548-1336-35.3.130.
Ferrer JR, Diago MP, Carbo JG. Analysis of the use of expansion osteotomes for the creation of implant beds. Technical contributions and review of the literature. Med Oral Patol Oral Cir Bucal 2006;11(3):267–271.
DeVico G, Bonino M, Spinelli D, et al. Clinical indications, advantages and limits of the expansion-condensing osteotomes technique for the creation of implant bed. Oral Implantol (Rome) 2009;2(1):27–36.
Sadeghi R, Rokn AR, Miremadi A. Comparison of implant stability using resonance frequency analysis: osteotome versus conventional drilling. J Dent (Tehran) 2015;12(9):647–654.
Atsumi M, Park SH, Wang HL. Methods used to assess implant stability: current status. Int J Oral Maxillofac Implants 2007;22(5):743–754.
Misic T, Markovic A, Todorovic A, et al. An in vitro study of temperature changes in type 4 bone during implant placement: bone condensing versus bone drilling. Oral Surg Med Oral Pathol Oral Radiol Endod 2011;112(1):28–33. DOI: 10.1016/j.tripleo.2010.08.010.
Esposito M, Hirsch JM, Lekholm U, et al. Biologic factors contributing to failures of osseointegrated oral implants. (I). Success criteria and epidemiology. Eur J Oral Sci 1998;106(1):527–551. DOI: 10.1046/j.0909-8836..t01-2-.x.
Javed F, Romanos GE. The role of primary stability for successful immediate loading of dental implants. A literature review. J Dent 2010;38(8):612–620. DOI: 10.1016/j.jdent.2010.05.013.
Simonis P, Dufour T, Tenebaum H. Long term implant survival and success: a 10–16-year follow-up of non-submerged dental implants. Clin Oral Implants Res 2010;21(7):772–777. DOI: 10.1111/j.1600-0501.2010.01912.x.
Bardyn T, Gedet P, Hallermann W, et al. Quantifying the influence of bone density and thickness on resonance frequency analysis: an in vitro study of biomechanical test materials. Int J Oral Maxillofac Implants 2009;24(6):1006–1014.
Degidi M, Daprile G, Piattelli A. Influence of underpreparation on primary stability of implants inserted in poor quality bone sites: an in vitro study. J Oral Maxillofac Surg 2015;73(6):1084–1088. DOI: 10.1016/j.joms.2015.01.029.
Meredith N. A review of Implant design, geometry and placement. Appl Osseointgrated Res 2008;6:6–12.
Summers RB. A new concept in maxillary implant surgery: part 1: the osteotome technique. Compendium 1994;15(2):152–162.
Alghamdi H, Anand PS, Anil S. Undersized implant preparation to enhance primary implant stability in poor bone density: a prospective clinical study. J Oral Maxillofac Surg 2011;69(12):e506–512. DOI: 10.1016/j.joms.2011.08.007.
Akca K, Chang TL, Tekdemir I, et al. Biomechanical aspects of initial intraosseous stability and implant design: a quantitative micro-morphometric analysis. Clin Oral Implants Res 2006;17(4):465–472. DOI: 10.1111/j.1600-0501.2006.01265.x.
Albektsson T, Albrektsson B. Osseointegration of bone implants. A review of an alternative mode of fixation. Acta Orthop Scand 1987;58(5):567–577. DOI: 10.3109/17453678709146401.
Elias CN, Rocha FA, Nascimento AL, et al. Influence of implant shape, surface morphology, surgical technique and bone quality on the primary stability of dental implants. J Mech Behav Biomed Mater 2012;16:169–180. DOI: 10.1016/j.jmbbm.2012.10.010.
Hong J, Lim YJ, Park SO. Quantative biomechanical analysis of the influence of the cortical bone and implant length on primary stability. Clin Oral Implants Res 2012;23(10):1193–1197. DOI: 10.1111/j.1600-0501.2011.02285.x.
Tabassum A, Mejier GJ, Wolke JGC, et al. Influence of the surgical technique and surface roughness on the primary stability of an implant in artificial bone with a density equivalent to maxillary bone: a laboratory study. Clin Oral Implants Res 2009;20(4):327–332. DOI: 10.1111/j.1600-0501.2008.01692.x.
Ahn SJ, Leesungbok R, Lee SW, et al. Differences in implant stability associated with various methods of preparation of implant bed: an in-vitro study. J Prosthet Dent 2012;107(6):366–372. DOI: 10.1016/S0022-3913(12)60092-4.
Bajaj G, Bathiya A, Gade JK, et al. Primary versus secondary implant stability in immediate and early loaded implants. Int J Oral Health Med Res 2017;3(5):49–54.
Shahid RM, Sadaqah NR, Othman SA. Does the implant surgical technique affect the primary and/or secondary stability of dental implants? A systematic review. Int J Dent 2014;2014:204838. DOI: 10.1155/2014/204838.
Martinez H, Davarpanah M, Missika P, et al. Optimal implant stability in low-density bone. Clin Oral Implants Res 2001;12(5):423–432. DOI: 10.1034/j.1600-0501.2001.120501.x.
Buchter A, Kleinheinz J, Wiesmann HP, et al. Biologic and biomechanical evaluation of bone remodeling and implant stability after using an osteotome technique. Clin Oral Implants Res 2005;16(1):1–8. DOI: 10.1111/j.1600-0501.2004.01081.x.
Nobrega AN, Norton A, Silva JA, et al. The osteotome technique versus conventional drilling technique for implant site preparation: a comparative study in the rabbit. Int J Periodontics Restorative Dent 2012;32(3):e109–115.
Summers RB. The osteotome technique: part 2: the ridge expansion osteotomy (REO) procedure. Compendium 1994;15(4):422–436.
Petrov SD, Drew HJ, Sun S. Sequencing osteotomes to overcome challenges presented by deficient bone quantity and quality in potential implant sites. Quintessence Int 2011;42(1):9–18.
Sakoh J, Wahlmann U, Stender E, et al. Primary stability of a conical implant and a hybrid, cylinder screw-type implant in vitro. Int J Oral Maxillofac Implants 2006;21:560–566.
Shayesteh YS, Khojasteh A, Siadat H, et al. A comparative study of crestal bone loss and implant stability between osteotome and conventional implant insertion techniques: a randomized controlled trial clinical trial study. Clin Implant Dent Relat Res 2013;15(3):350–357. DOI: 10.1111/j.1708-8208.2011.00376.x.
Shalabi MM, Wolke JG, deRujiter AJ, et al. A mechanical evaluation of implants placed with different surgical techniques into trabecular bone of goats. J Oral Implantol 2007;33(2):51–58. DOI: 10.1563/0-827.1.
Bayarchimeg D, Namgoong H, Kim BK. Evaluation of the correlation between insertion torque and primary stability of dental implants using block bone test. J Periodontal Implant Sci 2013;43(1):30–36. DOI: 10.5051/jpis.2013.43.1.30.
Tabassum A, Mejier GJ, Walboomers XF, et al. Evaluation of primary and secondary stability of titanium implants using different surgical techniques. Clin Oral Implants Res 2014;25(4):487–492. DOI: 10.1111/clr.12180.
Sennerby L, Meredith N. Implant stability measurements using resonance frequency analysis: biological and biomechanical aspects and clinical implications. Periodontol 2000 2008;47:51–65. DOI: 10.1111/j.1600-0757.2008.00267.x.
Cavallaro J, Greenstein B, Greenstein G. Clinical methodologies for achieving primary dental implant stability. J Am Dent Assoc 2009;140(11):1366–1372. DOI: 10.14219/jada.archive.2009.0071.
Gallucci GO, Benic GI, Eckert SE, et al. Consensus statements and clinical recommendations for implant loading protocols. Int J Oral Maxillofac Implants 2014;29 Suppl:287–290. DOI: 10.11607/jomi.2013.g4.
Cehreli MC, Karasoy D, Akca K, et al. Meta-analysis of methods used to assess implant stability. Int J Oral Maxillofac Implants 2009;24(6):1015–1032.
El-Dibany RM, El-Didi FH. Biological and histological evaluation of bone surrounding dental implants: threaded expanders vs osteotomes. Egypt Dent J 2009;55(1):321–330.